Chorus or Cacophony? Cicada Song Hits Some Ears Harder Than Others
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ST. LOUIS — Shhhooo. Wee-uuu. Chick, chick, chick. That’s the sound of three different cicada species. For some people, those sounds are the song of the summer. Others wish the insects would turn it down. The cacophony can be especially irritating for people on the autism spectrum who have hearing sensitivity.
Warren Rickly, 14, lives in suburban south St. Louis County, Missouri. Warren, who has autism, was at the bus stop recently waiting for his younger brother when the sound of cicadas became too much to bear.
“He said it sounds like there’s always a train running next to him,” his mother, Jamie Reed, said.
Warren told her the noise hurt.
Starting this spring, trillions of the red-eyed insects crawled their way out of the ground across the Midwest and Southeast. It’s part of a rare simultaneous emergence of two broods — one that appears every 13 years, the other every 17.
The noisy insects can be stressful. People with autism can have a sensitivity to texture, brightness, and sound.
“I think the difference for individuals with autism is the level of intensity or how upsetting some of these sensory differences are,” said Rachel Follmer, a developmental and behavioral pediatrician at Lurie Children’s Hospital in Chicago.
“It can get to the extreme where it can cause physical discomfort,” she said.
When a large group of cicadas starts to sing, the chorus can be as loud as a motorcycle. Researchers at the University of Missouri-St. Louis this year crowdsourced cicada noise levels as high as 86 decibels, about as loud as a food blender.
That can be stressful, not melodic, Follmer said.
To help children cope, she suggests giving them a primer before they encounter a noisy situation. For cicadas, that could mean explaining what they are, that they don’t bite or sting, and that they’ll be here for just a short time.
“When something is uncomfortable, not having power in that situation can be very scary for a lot of individuals, whether you’re on the spectrum or not,” Follmer said.
Jamie Reed’s family has been using this and other strategies to help her son. Warren wears noise-canceling headphones, listens to music, and has been teaching himself about cicadas.
“For him, researching it and looking into it I think grounds him a little bit,” Reed said.
Fatima Husain is a professor and neuroscientist at the University of Illinois Urbana-Champaign and studies how the brain processes sound. She said people with tinnitus may also struggle with cicada song.
Tinnitus, a ringing or other noise in the ears, is a person’s perception of sound without an external source.
“Some people say it sounds like buzzing, like wind blowing through trees, and ironically, quite a few people say it sounds like cicadas,” Husain said.
For most people with tinnitus the cicada’s song is harmless background noise, according to Husain, but for others the ringing can prevent easy conversation or sleep. Those with tinnitus are also more likely to have anxiety or depression. A loud persistent sound, like singing cicadas, can make someone’s tinnitus worse, Husain said.
It’s not always bad, though. The cicada’s song can also be a relief.
For some, tinnitus gets worse in a quiet environment. Husain said she’s seen reports this year of patients saying the cicadas’ song has been like soothing white noise.
“The sound is loud enough that in some ways it’s drowning their internal tinnitus,” Husain said.
As loud as the cicadas can be, they won’t necessarily damage anyone’s hearing, according to the Centers for Disease Control and Prevention. Hearing loss builds up over time from repeated exposure to loud sounds. Cicadas aren’t loud enough for long enough to do lasting damage, Husain said.
Everyday sources of noise come with a higher risk. Husain said constant exposure to loud highways, an airport, industrial sites, or household appliances like blenders and hair dryers can be a concern. And they can take a toll on someone’s emotional well-being.
“If you are being exposed to very loud sounds for a part of your school day or your working day, it may make you more stressed out; it may make you more angry about things,” she said.
Unlike the highway or an airport, cicadas won’t be around long. Most of the current brood will be gone in the next few weeks. Just in time for another noisy summer event: the Fourth of July.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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How they did it: STAT reporters expose how ailing seniors suffer when Medicare Advantage plans use algorithms to deny care
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In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.
The STAT stories had a far-reaching impact:
- The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
- Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
- In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
- Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm.
- Amid scrutiny, UnitedHealth renamed NaviHealth.
The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.
Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.
1. Search public comments on proposed federal rules to find sources.
Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.
There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.
Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.
The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.
“These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.
“The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”
The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.
2. Harness the power of the reader submission box.
At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.
The floodgates opened. Hundreds of submissions arrived.
By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.
(Screenshot of STAT’s submission box.) The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.
The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”
3. Mine podcasts relevant to your story.
The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.
But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.
The reporters also used the podcast to get Scully on the phone for an interview.
“So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”
4. When covering AI initiatives, proceed with caution.
“A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”
AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”
He suggests several questions to ask about the data behind AI tools:
- Where does the data come from?
- Who does it represent?
- How is this tool being applied?
- Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
- How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?
5. Localize the story.
More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.
“So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.
Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.
The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.
“It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.
There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.
Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.
6. Get familiar with Medicare’s appeals databases
Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.
“Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”
There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.
CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.
Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.
CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.
7. Give your editor regular updates.
“Sprinkle the breadcrumbs in front of your editors,” Ross says.
“If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.
8. Get that first story out.
“You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”
Read the stories
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care
UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Avocado vs Olives – Which is Healthier?
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Our Verdict
When comparing avocado to olives, we picked the avocado.
Why?
Both are certainly great! And when it comes to their respective oils, olive oil wins out as it retains many micronutrients that avocado oil loses. But, in their whole form, avocado beats olive:
In terms of macros, avocado has more protein, carbs, fiber, and (healthy) fats. Simply, it’s more nationally-dense than the already nutritionally-dense food that is olives.
When it comes to vitamins, olives are great but avocados really shine; avocado has more of vitamins B1, B2, B3, B5, B6, B7 B9, C, E, K, and choline, while olives boast only more vitamin A.
In the category of minerals, things are closer to even; avocado has more magnesium, manganese, phosphorus, potassium, and zinc, while olives have a lot more calcium, copper, iron, and selenium. Still, a marginal victory for avocado here.
In short, this is another case of one very healthy food looking bad by standing next to an even better one, so by all means enjoy both—if you’re going to pick one though, avocado is the more nutritionally dense.
Want to learn more?
You might like to read:
Avocado Oil vs Olive Oil – Which is Healthier? ← when made into oils, olive oil wins, but avocado oil is still a good option too
Take care!
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Overdone It? How To Speed Up Recovery After Exercise
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How To Speed Up Recovery After A Workout (According To Actual Science)
Has your enthusiasm ever been greater than your ability, when it comes to exercise?
Perhaps you leapt excitedly into a new kind of exercise, or maybe you made a reprise of something you used to do, and found out the hard way you’re not in the same condition you used to be?
If you’ve ever done an exercise session and then spent the next three days recovering, this one’s for you. And if you’ve never done that? Well, prevention is better than cure!
Post-exercise stretching probably won’t do much to help
If you like to stretch after a workout, great, don’t let us stop you. Stretching is, generally speaking, good.
But: don’t rely on it to hasten recovery. Here’s what scientists Afonso et al. had to say recently, after doing a big review of a lot of available data:
❝There wasn’t sufficient statistical evidence to reject the null hypothesis that stretching and passive recovery have equivalent influence on recovery.
Data is scarce, heterogeneous, and confidence in cumulative evidence is very low. Future research should address the limitations highlighted in our review, to allow for more informed recommendations.
For now, evidence-based recommendations on whether post-exercise stretching should be applied for the purposes of recovery should be avoided, as the (insufficient) data that is available does not support related claims.❞
…and breath! What a title.
Hot and Cold
Contrast bath therapy (alternating hot and cold, which notwithstanding the name, can also be done in a shower) can help reduce muscle soreness after workout, because of how the change in temperature stimulates vasodilation and vasoconstriction, reducing inflammation while speeding up healing:
Contrast Water Therapy and Exercise Induced Muscle Damage: A Systematic Review and Meta-Analysis
If doing this in the shower isn’t practical for you, and you (like most people) have only one bathtub, then cold is the way to go for the most evidence-based benefits:
Whole-Body Cryotherapy in Athletes: From Therapy to Stimulation. An Updated Review of the Literature
Eat protein whenever, carbs after
Eating protein before a workout can boost muscle protein synthesis. Be aware that even if you’re not bodybuilding, your body will still need to do cell replacement and repair, including in any muscle tissue that got damaged* during the workout
If you don’t like eating before a workout, eating protein after is fine too:
Pre- versus post-exercise protein intake has similar effects on muscular adaptations
*Note: muscle tissue is supposed to get damaged (slightly!) during many kinds of workout.
From lactic acid (that “burn” you feel when exercising) to microtears, the body’s post-workout job is to make the muscle stronger than before, and to do that, it needs you to have found the weak spots for it.
That’s what exercise-to-exhaustion does.
Eating carbs after a workout helps replace lost muscle glycogen.
For a lot more details on optimal nutrition timing in the context of exercise (carbs, proteins, micronutrients, different kinds of exercise, etc), check out this very clear guide:
International society of sports nutrition position stand: nutrient timing
Alcohol is not the post-workout carb you want
Shocking, right? But of course, it’s very common for casual sportspeople to hit the bar for a social drink after their activity of choice.
However, consuming alcohol after exercise doesn’t merely fail to help, it actively inhibits glycogen replacement and protein synthesis:
Also, if you’re tempted to take alcohol “to relax”, please be aware that alcohol only feels relaxing because of what it does to the brain; to the rest of the body, it is anything but, and also raises blood pressure and cortisol levels.
As to what to drink instead…
Hydrate, and consider creatine and tart cherry supplementation
Hydration is a no-brainer, but when you’re dehydrated, it’s easy to forget!
Creatine is a very well-studied supplement, that helps recovery from intense exercise:
Tart cherry juice has been found to reduce muscle damage, soreness, and inflammation after exercise:
Wondering where you can get tart cherry powder? We don’t sell it (or anything else), but here’s an example product on Amazon.
And of course, actually rest
That includes good sleep, please. Otherwise…
Effects of Sleep Deprivation on Acute Skeletal Muscle Recovery after Exercise
Rest well!
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Before You Reach For That Tylenol…
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First, on names: we’ve titled this with “Tylenol” because that’s a well-known brand name, but the drug name is paracetamol or acetaminophen:
- paracetamol is the drug name used by the World Health Organization, and thus also most countries.
- acetaminophen is the drug name used in Canada, Colombia, Iran, Japan, US, and Venezuela.
They are absolutely the same drug.
Firstly, obviously, do avoid overdose
The safe dosage described on the packet is generally accurate (usually around 4g/day, spaced out at 1g per 4 hours), and the dose required for toxicity is generally about 10g, or 200mg/kg body weight, whichever is lower. Since a single dose usually contains 2x 500mg = 1g, that makes overdose all too easy.
The amount required for toxicity can be misleading too, because that’s assuming…
- a healthy liver
- no other health problems
- no other medications that interact or add to the toxicity
- no medications that strain the liver (as with many pro-drugs, and drugs in general that are metabolized by the liver, which is lots).
Which is a lot of assumptions! Especially given that the liver can only process so much at once, meaning that if your liver has a lot of things to do, it can get a backlog, and you think “I’m not taking anything with this painkiller that I shouldn’t” but your liver is still metabolizing the last of last night’s glass of wine and one of your regular medications from this morning, because previously it was still metabolizing things from the day before yesterday, and so on.
See also: How To Regenerate Your Liver ← the liver is an incredible organ that does an amazing job, but it can’t do that if you don’t do this
Please don’t overdose deliberately either. Intentional overdoses make up a very large portion of acetaminophen overdoses (exact figures vary from year to year and place to place, but it’s always high), and what a lot of people doing that don’t realize is:
- it’s a very unpleasant way to die. You’ll take it, you might get some initial symptoms within the first hours or you might not, then you’ll probably feel better, and then the next day or so, you’ll enter the organs-shutting-down stage that usually will take most of a week to kill you slowly and painfully. Often your kidneys will go first but it’ll usually be liver necrosis that deals the final blow.
- it’s very difficult to treat. Stomach-pumping might work if you get it within 1 hour of overdose, and activated charcoal might help if you get it within 2 hours. Acetylcysteine may reduce the toxicity if you get it within the 8–48 hour window (depending on the speed of gastric emptying), but whether or not that will help depends on the severity of the overdose and other factors, so this is not something to bet on. After 48 hours, a liver transplant is the last resort, without which, mortality is around 95%.
Unfortunately, this means that a lot of people who do not intend to die horribly, and hoped to either die peacefully or else be saved, die horribly instead.
Ok, that was not a cheerful topic but it is important, before moving on, we’ll just put this here for anyone it may benefit:
How To Stay Alive (When You Really Don’t Want To) ← this is about suicidality, in yourself or others
Secondly, that dosage is for occasional use only
The problem often starts like this:
❝Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications❞
People with chronic pain, whether high or low on the pain level of that chronic pain, can very easily get into a habit of “I’ll just take this to take the edge off”, for example when getting up in the morning (often a trigger for pain starting) or going to bed at night (one needs to sleep and the pain is a barrier to that).
But… Those events, getting up and going to bed, it means that taking the drug also becomes part of one’s morning/evening routine—with many people even metering the doses out into pill organizers for the week, with this in mind.
A large (n=582,961) study looked at two groups of people, all aged 65+:
- 180,483 people who had been prescribed paracetamol repeatedly (≥2 prescriptions within six months)
- 402,478 people of the same age who had never been prescribed paracetamol repeatedly
The findings? Bearing in mind that “≥2 prescriptions within six months” is not something generally considered excessive…
❝Acetaminophen use was associated with an increased risk of peptic ulcer bleeding (aHR 1.24; 95% CI 1.16, 1.34), uncomplicated peptic-ulcers (aHR 1.20; 95% CI 1.10, 1.31), lower gastrointestinal-bleeding (aHR 1.36; 95% CI 1.29, 1.46), heart-failure (aHR 1.09; 95% CI 1.06, 1.13), hypertension (aHR 1.07; 95% CI 1.04, 1.11), and chronic kidney disease (aHR 1.19; 95% CI 1.13, 1.24).❞
The researchers concluded:
❝Despite its perceived safety, acetaminophen is associated with several serious complications. Given its minimal analgesic effectiveness, the use of acetaminophen as the first-line oral analgesic for long-term conditions in older people requires careful reconsideration.❞
You can see the study itself here: Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink
What to use instead?
It’s been established that taking aspirin regularly isn’t great either:
See: Low-Dose Aspirin & Anemia and Aspirin, CVD Risk, & Potential Counter-Risks
And as for ibuprofen, we don’t have an article about that yet, but it’s gut-unhealthy (harms your microbiome), and besides, anything it can do, ginger can do as well or better (in head-to-head trials; we’re not speaking hyperbolically here):
Ginger Does A Lot More Than You Think ← in fact, it was even found as effective as the combination of acetaminophen, ibuprofen, and caffeine
There are other options though, and as pain is complicated and there’s no one-size-fits-all solution, we’ve compiled the following:
- Dial Down Your Pain
- Stop Pain Spreading
- Managing Chronic Pain (Realistically!)
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief ← when painkillers aren’t helping, these things might
Take care!
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A person in Texas caught bird flu after mixing with dairy cattle. Should we be worried?
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The United States’ Centers for Disease Control and Prevention (CDC) has issued a health alert after the first case of H5N1 avian influenza, or bird flu, seemingly spread from a cow to a human.
A farm worker in Texas contracted the virus amid an outbreak in dairy cattle. This is the second human case in the US; a poultry worker tested positive in Colorado in 2022.
The virus strain identified in the Texan farm worker is not readily transmissible between humans and therefore not a pandemic threat. But it’s a significant development nonetheless.
Some background on bird flu
There are two types of avian influenza: highly pathogenic or low pathogenic, based on the level of disease the strain causes in birds. H5N1 is a highly pathogenic avian influenza.
H5N1 first emerged in 1997 in Hong Kong and then China in 2003, spreading through wild bird migration and poultry trading. It has caused periodic epidemics in poultry farms, with occasional human cases.
Influenza A viruses such as H5N1 are further divided into variants, called clades. The unique variant causing the current epidemic is H5N1 clade 2.3.4.4b, which emerged in late 2020 and is now widespread globally, especially in the Americas.
In the past, outbreaks could be controlled by culling of infected birds, and H5N1 would die down for a while. But this has become increasingly difficult due to escalating outbreaks since 2021.
Wild animals are now in the mix
Waterfowl (ducks, swans and geese) are the main global spreaders of avian flu, as they migrate across the world via specific routes that bypass Australia. The main hub for waterfowl to migrate around the world is Quinghai lake in China.
But there’s been an increasing number of infected non-waterfowl birds, such as true thrushes and raptors, which use different flyways. Worryingly, the infection has spread to Antarctica too, which means Australia is now at risk from different bird species which fly here.
H5N1 has escalated in an unprecedented fashion since 2021, and an increasing number of mammals including sea lions, goats, red foxes, coyotes, even domestic dogs and cats have become infected around the world.
Wild animals like red foxes which live in peri-urban areas are a possible new route of spread to farms, domestic pets and humans.
Dairy cows and goats have now become infected with H5N1 in at least 17 farms across seven US states.
What are the symptoms?
Globally, there have been 14 cases of H5N1 clade 2.3.4.4b virus in humans, and 889 H5N1 human cases overall since 2003.
Previous human cases have presented with a severe respiratory illness, but H5N1 2.3.4.4b is causing illness affecting other organs too, like the brain, eyes and liver.
For example, more recent cases have developed neurological complications including seizures, organ failure and stroke. It’s been estimated that around half of people infected with H5N1 will die.
The case in the Texan farm worker appears to be mild. This person presented with conjunctivitis, which is unusual.
Food safety
Contact with sick poultry is a key risk factor for human infection. Likewise, the farm worker in Texas was likely in close contact with the infected cattle.
The CDC advises pasteurised milk and well cooked eggs are safe. However, handling of infected meat or eggs in the process of cooking, or drinking unpasteurised milk, may pose a risk.
Although there’s no H5N1 in Australian poultry or cattle, hygienic food practices are always a good idea, as raw milk or poorly cooked meat, eggs or poultry can be contaminated with microbes such as salmonella and E Coli.
If it’s not a pandemic, why are we worried?
Scientists have feared avian influenza may cause a pandemic since about 2005. Avian flu viruses don’t easily spread in humans. But if an avian virus mutates to spread in humans, it can cause a pandemic.
One concern is if birds were to infect an animal like a pig, this acts as a genetic mixing vessel. In areas where humans and livestock exist in close proximity, for example farms, markets or even in homes with backyard poultry, the probability of bird and human flu strains mixing and mutating to cause a new pandemic strain is higher.
There are a number of potential pathways to a pandemic caused by influenza. Author provided The cows infected in Texas were tested because farmers noticed they were producing less milk. If beef cattle are similarly affected, it may not be as easily identified, and the economic loss to farmers may be a disincentive to test or report infections.
How can we prevent a pandemic?
For now there is no spread of H5N1 between humans, so there’s no immediate risk of a pandemic.
However, we now have unprecedented and persistent infection with H5N1 clade 2.3.4.4b in farms, wild animals and a wider range of wild birds than ever before, creating more chances for H5N1 to mutate and cause a pandemic.
Unlike the previous epidemiology of avian flu, where hot spots were in Asia, the new hot spots (and likely sites of emergence of a pandemic) are in the Americas, Europe or in Africa.
Pandemics grow exponentially, so early warnings for animal and human outbreaks are crucial. We can monitor infections using surveillance tools such as our EPIWATCH platform.
The earlier epidemics can be detected, the better the chance of stamping them out and rapidly developing vaccines.
Although there is a vaccine for birds, it has been largely avoided until recently because it’s only partially effective and can mask outbreaks. But it’s no longer feasible to control an outbreak by culling infected birds, so some countries like France began vaccinating poultry in 2023.
For humans, seasonal flu vaccines may provide a small amount of cross-protection, but for the best protection, vaccines need to be matched exactly to the pandemic strain, and this takes time. The 2009 flu pandemic started in May in Australia, but the vaccines were available in September, after the pandemic peak.
To reduce the risk of a pandemic, we must identify how H5N1 is spreading to so many mammalian species, what new wild bird pathways pose a risk, and monitor for early signs of outbreaks and illness in animals, birds and humans. Economic compensation for farmers is also crucial to ensure we detect all outbreaks and avoid compromising the food supply.
C Raina MacIntyre, Professor of Global Biosecurity, NHMRC L3 Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney; Ashley Quigley, Senior Research Associate, Global Biosecurity, UNSW Sydney; Haley Stone, PhD Candidate, Biosecurity Program, Kirby Institute, UNSW Sydney; Matthew Scotch, Associate Dean of Research and Professor of Biomedical Informatics, College of Health Solutions, Arizona State University, and Rebecca Dawson, Research Associate, The Kirby Institute, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why is pain so exhausting?
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One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them.
In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the two biggest barriers to an active and meaningful life.
But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours.
simona pilolla 2/Shutterstock Short-term pain can protect you
Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe.
Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us.
When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it.
The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us they learned that helped them recover.
But long-term pain can overprotect you
In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes.
But persistent pain can overprotect us and prevent recovery. People in pain have called this “pain system hypersensitivity”. Think of this as your pain system being on red alert. And this is where exhaustion comes in.
When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued.
About 80% of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like.
Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties.
Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy.
Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying.
Concentrating hard, mustering energy and using distraction techniques can make everyday life exhausting. PRPicturesProduction/Shutterstock No wonder pain is exhausting
In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go hand in hand with chronic pain.
Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems.
Loss of sleep is also a factor in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain.
In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting.
What actually works?
People with chronic pain are stigmatised, dismissed and misunderstood, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage.
So we need better access to evidence-based care, with high-quality education for people with chronic pain.
There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, helps.
The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising.
Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong supportive evidence from clinical trials.
Every bit of support helps
The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted.
So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey.
More information about chronic pain is available from Pain Revolution.
Michael Henry, Physiotherapist and PhD candidate, Body in Mind Research Group, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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