Developmental dyslexia essential to human adaptive success: study

 Cambridge researchers studying cognition, behavior and the brain have concluded that people with dyslexia are specialized to explore the unknown. This is likely to play a fundamental role in human adaptation to changing environments.

They think this 'explorative bias' has an evolutionary basis and plays a crucial role in our survival.

Based on these findings—which were apparent across multiple domains from visual processing to memory and at all levels of analysis—the researchers argue that we need to change our perspective of dyslexia as a neurological disorder.

The findings, reported today in the journal Frontiers in Psychology, have implications both at the individual and societal level, says lead author Dr. Helen Taylor, an affiliated Scholar at the McDonald Institute for Archaeological Research at the University of Cambridge and a Research Associate at the University of Strathclyde.

"The deficit-centered view of dyslexia isn't telling the whole story," said Taylor. "This research proposes a new framework to help us better understand the cognitive strengths of people with dyslexia."

She added: "We believe that the areas of difficulty experienced by people with dyslexia result from a cognitive trade-off between exploration of new information and exploitation of existing knowledge, with the upside being an explorative bias that could explain enhanced abilities observed in certain realms like discovery, invention and creativity."

This is the first-time a cross-disciplinary approach using an evolutionary perspective has been applied in the analysis of studies on dyslexia.

"Schools, academic institutes and workplaces are not designed to make the most of explorative learning. But we urgently need to start nurturing this way of thinking to allow humanity to continue to adapt and solve key challenges," said Taylor.

Dyslexia is found in up to 20% of the general population, irrespective of country, culture and world region. It is defined by the World Federation of Neurology as "a disorder in children who, despite conventional classroom experience, fail to attain the language skills of reading, writing and spelling commensurate with their intellectual abilities".

The new findings are explained in the context of 'Complementary Cognition', a theory proposing that our ancestors evolved to specialize in different, but complementary, ways of thinking, which enhances human's ability to adapt through collaboration.

These cognitive specializations are rooted in a well-known trade-off between exploration of new information and exploitation of existing knowledge. For example, if you eat all the food you have, you risk starvation when it's all gone. But if you spend all your time exploring for food, you're wasting energy you don't need to waste. As in any complex system, we must ensure we balance our need to exploit known resources and explore new resources to survive.

"Striking the balance between exploring for new opportunities and exploiting the benefits of a particular choice is key to adaptation and survival and underpins many of the decisions we make in our daily lives," said Taylor.

Exploration encompasses activities that involve searching the unknown such as experimentation, discovery and innovation. In contrast, exploitation is concerned with using what's already known including refinement, efficiency and selection.

"Considering this trade-off, an explorative specialization in people with dyslexia could help explain why they have difficulties with tasks related to exploitation, such as reading and writing.

"It could also explain why people with dyslexia appear to gravitate towards certain professions that require exploration-related abilities, such as arts, architecture, engineering, and entrepreneurship."

The researchers found that their findings aligned with evidence from several other fields of research. For example, an explorative bias in such a large proportion of the population indicates that our species must have evolved during a period of high uncertainty and change. This concurs with findings in the field of paleoarchaeology, revealing that human evolution was shaped over hundreds of thousands of years by dramatic climatic and environmental instability.

The researchers highlight that collaboration between individuals with different abilities could help explain the exceptional capacity of our species to adapt.

The findings are published today in the journal, Frontiers in Psychology.

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Explore further

Greater than the sum of our parts: The evolution of collective intelligence

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More information: Developmental Dyslexia: Developmental Disorder or Specialization in Explorative Cognitive Search, Frontiers in Psychology (2022). DOI: 10.3389/fpsyg.2022.889245

https://medicalxpress.com/news/2022-06-developmental-dyslexia-essential-human-success.html

Biden admin quietly erasing immigration court caseload: 'De facto amnesty'

 Federal prosecutors are quietly dismissing stacks of cases against illegal immigrants under a Biden administration mandate that could be on pace to effectively pardon 1 million people by 2024, according to leaked information reviewed by the Washington Examiner.

Attorneys for U.S. Immigration and Customs Enforcement have begun to throw out tens of thousands of the 2 million backlogged cases in immigration court following a political appointee's order not to go after illegal border crossers from before the November 2020 election.

“This is a de facto amnesty,” said an ICE federal prosecutor who spoke with the Washington Examiner on the condition of anonymity.

The Washington Examiner obtained leaked video recordings of virtual meetings that Kerry Doyle, ICE's principal legal adviser, held with the more than 1,200 ICE prosecutors who bring cases against illegal immigrants nationwide, in which she explained in detail who should not be targeted for deportation. Illegal immigrants identified as national security and public safety threats, or those who had crossed the border illegally after Nov. 1, 2020, would be the only cases ICE would pursue. All others would be dropped.

"As the memo explains — I think pretty clearly — we've put our thumb sort of heavily in favor of dismissal and durable solutions," Doyle told her workforce in a private town hall meeting on April 14. "Even if you’ve spent a lot of time on the case, if it's a nonpriority, you should be moving to offer [prosecutorial discretion] in that case."

Doyle's mandate to close out cases took effect on April 25. An indicator of how quickly ICE has moved is the number of cases wiped out in those two months. Between 60,000 and 80,000 cases have been closed, according to the ICE attorney. The total case closures since the start of fiscal year 2022 last October is more than 97,000, according to data from the Transactional Records Access Clearinghouse, a research organization at Syracuse University in New York. Case closures eight months into 2022 are already up fourfold from all of 2021, another sign of how quickly ICE prosecutors are moving to clear the books.

If the agency's 1,200 prosecutors keep the current pace of 60,000-80,000 case closures every two months, ICE could hit 360,000 to 480,000 closed cases by next April and 1 million by early summer 2024, months before the presidential election.

Transactional Access Records Clearinghouse (https://trac.syr.edu/phptools/immigration/court_backlog/court_proctime_outcome.php)

Doyle cited the change in policy as a means of addressing the court backlog, which has exploded from 522,000 in 2016, according to Migration Policy Institute data.

And while the change stops short of the left-wing goal of abolishing ICE, the Biden administration policy has severely undercut the immigration law enforcement agency, ICE insiders told the Washington Examiner.

“Congress hasn’t passed it, but [Homeland Security Secretary Alejandro] Mayorkas’s chief lawyer at ICE is telling all prosecutors to dismiss cases. Once it’s dismissed, they’re not required to check in with you anymore," said the ICE federal prosecutor who spoke with the Washington Examiner on the condition of anonymity.

Since President Joe Biden took office, the number of noncitizens encountered attempting to enter the country illegally has soared, surpassing 2.75 million encounters as of last month. In that time, U.S. border officials took custody of and released into the United States 1,049,532 people, according to Justice Department court documents filed over the past year. Those released by the Border Patrol are told to show up to court about their immigration violations, an indicator of how many of the 2 million backlogged cases are from the Biden administration and how many others are being dismissed.

Information reviewed by the Washington Examiner shows a limited number of cases won't be dismissed under the new policy. Fewer than 50 cases fall under the national security priority and no more than 25,000 would be deemed a public safety threat. Illegal immigrants with criminal records would not be automatically considered a public safety threat. A person who had been previously deported and then arrested for illegally crossing the border again would also not be deemed a public safety concern, Doyle said.

"I don't see how you could argue that being a public safety concern — just the illegal reentry," Doyle said in the April 14 virtual town hall with employees, adding that there could be an argument that they fall under national security or border crossing priorities, but each case is unique.

"We aren't telling you, 'OK, if there's ... only two DUIs, it's not a priority and there's three DUIs, it is a priority,'" Doyle said. "It will depend ... on that particular case. Was the DUI, the two DUIs in the last two months? Or were the DUIs 20 years ago and the person ... shows that they're now ... being rehabilitated. They're now in recovery. And things are different. I mean, those are two very, very different scenarios."

In one example, Doyle said in cases in which a person has requested asylum and received a work permit while they await that asylum decision, an attorney should "as a general rule" still move to dismiss the case despite it costing the individual his or her ability to work legally in the country. She provided no alternative for the person to find work.

American Immigration Lawyers Association President Allen Orr commended the policy move as a way to address court backlogs, adding that the use of “prosecutorial discretion" was "nothing new or original.”

But the ICE attorney said the new policy leaves little room for prosecutors to use their own judgment.

“This mandatory requirement was imposed under the guise of ‘prosecutorial discretion’ and allegedly for the purpose of freeing up busy immigration prosecutors to focus on the most important cases. But this is a canard. There is no actual discretion," the ICE attorney said. "Do as Doyle commands or else.”

Andrew R. Arthur, former immigration judge and resident fellow of law and policy at the right-leaning Center for Immigration Studies in Washington, pointed out that Doyle’s mandate is illogical and that the administration is forcing attorneys' hands.

“The whole idea behind ‘prosecutorial discretion’ is that the prosecutor exercises it or not. ‘Mandatory prosecutorial discretion’ is an oxymoron,” Arthur wrote in a recent blog post.

The tens of thousands of noncitizens who have been cleared from the immigration court dockets over the past eight weeks may now apply to become permanent legal residents, the prerequisite to becoming a U.S. citizen. An illegal border crosser is barred from applying for legal permanent residency as long as his or her case is pending in court. With no case pending, they may apply. Once approved, they may apply for adjustment of status to citizenship after five years.

"All those removable aliens will be able to live and work in the United States indefinitely — which, in this context, means forever or at least until they themselves decide to leave. That is the definition of an amnesty," Arthur wrote.

Legal permanent residents no longer have to extend their temporary work permits — they have permanent approval to work in the country. Once citizens, they are afforded the same ability to apply for any federal, state, or local benefits and assistance.

The Department of Homeland Security and ICE did not respond to requests for comment.

https://www.washingtonexaminer.com/policy/defense-national-security/biden-administration-quietly-erasing-immigration-court-caseload-de-facto-amnesty

When It’s Urgent

 EVEN THOUGH I’M NOT a doctor, I’ve been around medicine all my life. My father was a general practitioner and I spent my career in hospital administration. I had administrative oversight over three emergency departments of varying sizes. Based on my experience, here are 10 recommendations that may improve your experience should you need to visit an emergency room:

1. If you use the emergency room (ER) for a non-acute medical condition, bring a book. The ER prioritizes based on the severity of the health issue, not on who arrives first. You’d want the same if you were there for a heart attack.

2. Tell the truth. No matter how embarrassing your condition or the circumstances surrounding your accident, the ER staff has heard it all. By knowing the background, the doctors and nurses will be better able to help.

3. Any medical history you can bring will be useful. Arriving with a list of medications, current medical problems, past surgeries and the names of your physicians will speed things along. The longer the list, the more important the information is. If you have advance directives, bring those as well. If all your health care is provided within the same health care system, the ER might have access to your electronic medical records, but don’t count on it.

4. Visit the ER that’s in-network for your health insurance unless it’s a life-or-death situation. Showing up at an out-of-network ER has “major hassle” and “hefty bill” written all over it, though it may be necessary if you’re traveling. When picking health insurance, think about the emergency room you’re most likely to use.

5. The ER physician and staff don’t know how your insurance works and they don’t care. There are innumerable health plans out there, and each has its own network and limitations. By going to an ER, you’re conveying that you have an acute medical condition. They’re there to solve that problem, regardless of cost.

6. Surprise medical bills are real, but they can sometimes be avoided. The ER physician may refer a given condition to X hospital because it’s 15 minutes closer than Y hospital, which is equally capable. If X hospital isn’t in your network, speak up if you’re able. The same goes for surgeons or other specialists who drop by to consult. To find in-network providers, you might call the number on the back of your insurance card or use your phone to go to your insurance company’s website.

7. Helicopters are wildly expensive and a huge source of billing surprises. When necessary, they save lives, but understand that they may come with a significant out-of-pocket cost. If a helicopter is proposed, it’s reasonable to ask whether using slower ground transport is too medically risky.

8. The ER staff isn’t necessarily there to provide a definitive diagnosis. Their job is to determine whether your condition will kill you, and then prevent that from happening. If you arrive with chest pains, that might suggest five or so fatal conditions. Once those are ruled out, you’re safe to go home or to an inpatient floor for a follow-up to determine if you have, say, chronic indigestion. Medical problems on TV may be resolved in an hour, commercials included, but the real world often doesn’t work that way.

9. Despite the convenience of 24/7 availability, an emergency room should not be a substitute for your primary care physician. There’s value to your ongoing relationship with your primary care doctor that’s lost in the ER. An ER doctor may head down a diagnostic path that makes sense based on what she sees, but wouldn’t make sense if she had the background your doctor has.

10. We live in a world where we can review ratings for many products and services, and this is starting to be the case for physicians. You don’t have a choice of which doctor you’ll see in the ER. Still, evaluating them by previous patients’ reviews may be shortsighted.

In the 1980s, hospitals started doing patient satisfaction surveys. I decided to share the physician-specific comments we received on our ER survey with each of our ER doctors. One consistently had the lowest satisfaction ratings. As I explored the reasons, I came to understand that he was very introverted and wasn’t one for small talk.

No one ever said he was mean or inappropriate. Meanwhile, the ER nursing director rated him the highest for his medical skills. The other members of the medical staff all said they hoped he would be the one on duty if they arrived with a heart attack.

Hospital administrators would love to only have doctors who are highly skilled and highly personable. Just remember, if your ER physician doesn’t bubble the way you think he should, his previous case may have necessitated telling a family that a child just died. Cut him some slack.

Howard Rohleder, a former chief executive of a community hospital, retired early after more than 30 years in hospital administration. In retirement, he enjoys serving on several nonprofit boards, exploring walking paths with his wife Susan, and visiting their six grandchildren. A little-known fact: In May 1994, Howard was featured—along with five others—on the cover of Kiplinger’s Personal Finance for an article titled “Secrets of My Investment Success.” 

https://humbledollar.com/2022/06/when-its-urgent/

Immunologist Fights Covid with Tweets and a Nasal Spray

 In the United States and some other countries, the Covid-19 pandemic has entered a paradoxical stage in which the coronavirus has evolved into a highly contagious variant and sent cases soaring, but the public’s attitude has evolved toward indifference, deflating precautionary measures.

Immunologists like Akiko Iwasaki of the Yale School of Medicine, keenly aware that the consequences of the unfinished pandemic are still playing out, continue to combat the virus in the lab. “The enemy has evolved, and the world needs next-generation vaccines to respond,” Iwasaki recently wrote in an op-ed column for The New York Times. Although current vaccines against the coronavirus are highly effective at preventing severe disease and death, they are less successful at preventing infection. Vaccines in the form of a spritz up the nose could change that, Iwasaki said, by heading off infections and the array of symptoms known as “long Covid” that linger for many former patients.

Iwasaki’s group at Yale, like other laboratories around the world, is developing such nasal sprays. She and her team are also trying to tease apart the mystery of long Covid and why only some people are afflicted with it.

The pandemic “has transformed my own science,” said Iwasaki, who like many other researchers reoriented her lab toward studies of the coronavirus at the start of the pandemic. Previously, much of her laboratory’s work had looked at how the portion of the body’s defenses called the innate immune system detects viruses and how that helps to prime the immune responses in mucous membranes.

Around that same time, in March 2020, Iwasaki found the boundary between her job and her personal life dissolving, because what had been niche conversational topics about immunology with colleagues and students suddenly became of great interest to the public. With a deluge of alarming reports about Covid flooding the news, Iwasaki found herself becoming a lifeline for the worried and the curious who came to her on Twitter with questions.

She teaches on social media, and knocks down misinformation, with the same fervor that she brings to her research — and is eminently qualified for both battles. In 2018, Iwasaki was elected to the National Academy of Sciences and in the following year to the National Academy of Medicine. In 2021, she was elected to the European Molecular Biology Organization and to the American Academy of Arts and Sciences. She is also leading a newly launched Yale Center for Infection and Immunity that will expand her research into diagnoses, treatments and nasal vaccine development for infectious diseases.

Quanta spoke with Iwasaki about the evolution of the pandemic, her efforts to teach the public and why she thinks the nasal spray may be the new weapon that we need. The interview has been condensed and edited for clarity.

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Iwasaki examines slices of brain tissue on exhibit at the Cushing Center at Yale University.

 

 

Brandon Schulman for Quanta Magazine

Could nasal sprays change how we fight this pandemic and the future ones?

I think it’s going to fundamentally change the way we approach vaccines against pathogens, especially the ones that are coming through mucosal surfaces like the nose. We can apply the same strategy to other respiratory pathogens, like the influenza virus, adenovirus or the rhinovirus. What we need to do is to take advantage of the regular, intramuscular vaccine as a primary vaccine and piggyback onto that with a nasal spray.

How would that work?

After someone is vaccinated with one of the available intramuscular vaccines, you just spray a simple protein, a recombinant spike protein, into the nose. And that converts the systemic immunity [from the injection] into mucosal immunity. The strategy is called “prime and spike.”

The key is that we are taking advantage of the existing immune response by the T cells that people have from previous vaccinations. That means we don’t have to use any adjuvant, or extra molecule, to stimulate an immune response, which is advantageous because it minimizes unwanted side effects.

Why are mucosal surfaces good places to elicit immune reactions?

Mucosal surfaces are the wet surfaces that line your nasal cavity, oral cavity, your genital tract or gastrointestinal cavity. It’s where most pathogens enter our bodies unless you get exposed to them through a cut or a vector like a mosquito or a tick. It’s the first line of defense against pathogens.

If mucosal surfaces are a first line of defense to pathogens, why don’t current Covid-19 vaccines target them?

Well, that’s a great question; we wonder the same thing. Most vaccines are given into a muscle with a needle. And those vaccines are really good at inducing systemic and circulating immune responses. But they’re not designed to elicit mucosal immunity. That is not part of the vaccine design right now. We’re trying to change that.

Viral plaque assays, in which fluids contaminated with viruses are spread on cells growing in culture, enable Iwasaki and other immunologists to quantify how much virus is present in a sample.

Brandon Schulman for Quanta Magazine

When I was growing up, I remember there being an option to get a flu vaccine as a nasal spray. Is this the same idea?

Exactly. So that is called FluMist and it’s given to people between 2 and 49 years of age. It works really nicely because it induces this local immune response. But as with all other flu vaccines, it’s always a gamble trying to guess the right antigen. With the coronavirus, you don’t need to guess anything — you know exactly what you need.

And that is to target the coronavirus spike protein?

Yes. The spike protein is the target, but it will change as variants arise. Instead of chasing the next variant, we want to generate a broadly reactive immune response to current variants that can also cross-react with future variants. This can be achieved by using a different spike protein. We used SARS-CoV-1 spike protein for this purpose.

Would nasal spray vaccines be as effective as the intramuscular vaccines currently being used to battle the virus?

I would think that it will be more effective. We still have to test it in humans, but because the spray vaccine establishes local immunity where the virus enters the body, people may not get infected from the pathogen, which is very different from the intramuscular vaccines where we’re preventing severe disease. If you don’t get infected, of course, you avoid any downstream consequences, like long Covid.

Another advantage is that it’s a nasal spray, so you don’t necessarily rely on health care personnel to deliver it. You may just get it from your local pharmacy and administer it yourself. That also expands the scope to other countries that may not have the workforce to deliver intramuscular vaccine but may have the capacity to deliver nasal spray. It’s also very easy to produce: It’s just a recombinant protein that can be stored in the fridge for a few months.

I hate needles!

Many people do. And they may find a nasal spray much more amenable.

Would the nasal spray also somehow build up immunity in the mouth, which is another place through which we can be infected?

That is something we are looking at right now in hamsters. We hope to find the answer soon.

“When the pandemic hit, it was kind of natural for me to start teaching those who are interested,” Iwasaki said.

Brandon Schulman for Quanta Magazine

What are the challenges of getting mucosal vaccines to work? Why don’t we have one already?

The challenge of getting mucosal vaccines is that the mucus layer blocks the uptake of antigens and vaccines, making it a difficult barrier to deliver vaccines. That is why most existing mucosal vaccines are based on weakened forms of live viruses that have their own strategy to penetrate the mucus layer and produce antigens. Our “prime and spike” approach does not require replicating or live pathogens. Even a small amount of the recombinant spike is enough to trigger robust immunity because we are leveraging memory T cells from the previous vaccine to activate antigen-presenting cells in the mucus layer.

Are there candidate mucosal vaccines for the coronavirus that are already in clinical trials? When would you predict that such vaccines will be released?

Yes, several are in clinical trials. Depending on the results, I am hoping that some of these can be approved for human use soon.

Your lab is also focused on understanding what causes long Covid, right?

We are putting our effort now into trying to understand long Covid, yes. Long Covid is a debilitating condition for millions of people now. It’s estimated that 10% to 30% of people get long Covid after infections.

It has over 200 associated symptoms, involving every organ system. Some people have a couple of them, while others have over a dozen. Some people recover after several weeks, and others do not. So it’s a very heterogeneous disease, but there are four hypotheses we are testing now to see what people are actually suffering from.

What are the four hypotheses?

It could be viral remnants or an infectious pool of viruses hidden somewhere in the body that’s still causing symptoms but not leading the person to test positive on PCR tests. It could be autoimmunity or immune system cells themselves that are driving the symptoms. It could be the reactivation of other silent viruses or microbiome changes. Or tissue damage from the infection or treatment may be lingering or turning into fibrosis or chronic disease.

“Immunology as a discipline is a very deep field; we will never understand everything,” Iwasaki said. “I think that this pandemic has highlighted a few things that we still need to work on.”

Brandon Schulman for Quanta Magazine

People with chronic fatigue syndrome have similar symptoms, right?

Exactly. People who have been suffering from chronic fatigue syndrome over the years have been largely ignored or dismissed. Many doctors kind of think that this is a psychiatric disease instead of something that’s happening outside the brain. I think that this whole viewpoint needs to change. And there are so many other pathogens that lead to these kinds of post-infectious syndromes. So I don’t want people to think of this as a unique feature of Covid.

You quickly became a leading and guiding voice during the pandemic. Did that happen organically?

I’ve always loved teaching. I’ve been teaching immunology at Yale for a long time now. And, you know, teaching is also learning. I do a lot of reading to catch up with all the different advances in immunology, and oftentimes I pick up things that I didn’t know before. Students’ questions also trigger me to investigate what we don’t yet understand in immunology. So, when the pandemic hit, it was kind of natural for me to start teaching those who are interested.

Before the pandemic, I had a Twitter account where I was tweeting about immunology or issues with academia and women in science, things like that. I would post Twitter threads about our lab’s work and a few immunologists would like the post. But there was a huge switch in the general public’s interest in viruses and immunity once the pandemic hit. People outside of immunology became very interested in our work — not only other scientists but also the general public, journalists and reporters. All of a sudden, people wanted to learn about the immune system and how it works, and people started talking about antibody levels and T cells. This transition happened pretty much over March 2020. I think the first thing that really kind of put me on the stage was this Tweetorial [a tutorial as a Twitter thread] that I did about a video I made called “Immunology 101 for non-immunologists,” just to describe what the immune system does.

“There’s a lot of stereotypes against women in science and implicit biases that are working against us,” said Iwasaki, who has become a prominent advocate and mentor for women and minorities in science.

Brandon Schulman for Quanta Magazine

You also do a lot to advocate for women and minorities in science. Where did your passion for that come from?

I grew up watching my mother suffer from this kind of injustice. She worked at a radio station. At that time, when women became pregnant, to some extent they were expected to quit their job. She has three daughters, and every time she would have the babies, people pressured her to leave the company. She’s been jeered at and harassed and faced horrible things. But she never quit the company and instead formed a sort of network of other women and men to fight for the right to work. Watching this and hearing about it really influenced me to think that we need to stand up. There’s a lot of stereotypes against women in science and implicit biases that are working against us.

Is your mom your role model?

Absolutely, yes, she is. And so is my father.

You’re a role model for the younger generation as well. I saw on your Twitter account a photo of a fourth grader presenting about long Covid with inspirational quotes from you.

That was such a heartwarming post. I loved it. I’m just so delighted that people looking at me are thinking about science and thinking about immunology. It’s amazing that a young person like that is thinking about long Covid and research. And that is just so inspirational for me in return.

Did you always know you were going to be an immunologist?

I didn’t know that. I grew up in a very progressive household, where my parents encouraged me to pursue whatever I wanted. It was in high school that I met a math teacher who instilled this interest and excitement for math in me. I started taking more math classes and decided that maybe I’ll go into science instead of literature, which is what I wanted to do before that. I left Japan when I was 16 to explore the world and see what’s out there. I finished high school in Canada, and then I went to undergraduate and graduate work at the University of Toronto, which was really formative for me in trying myself out in a different environment. That’s also where I learned the joy of immunology, starting in my senior year when I took an introductory course and learned about how vaccines work and how they save millions of lives. I thought, wow, what could be more interesting and fulfilling than to study the immune system?

Brandon Schulman for Quanta Magazine

If you went back to that class today, do you think that the teachings would be very different?

Oh yeah, I hope so. We’ve learned so much since then. When I took that class, the innate immune system wasn’t really understood well. It was only in 1997 that Ruslan Medzhitov, who is now my husband, in Charlie Janeway’s lab figured out that innate signaling through recognition of pathogen-associated molecular patterns is what triggers adaptive immunity. That revolutionized the way we think about how the pathogen is being recognized by the immune system. That’s the basis of adjuvants. Back then, we had no idea about these things. It was not taught at all.

Even now, though, how much do we understand the immune system? Are there still major gaps that need to be filled?

Immunology as a discipline is a very deep field; we will never understand everything. So I think that this pandemic has highlighted a few things that we still need to work on, one of which is mucosal immunity. It’s been a subfield of immunology that hasn’t gotten a lot of public attention. And then what are the molecular pathways and trafficking patterns? All these things are worked out for some tissues, like the gut, but not in the respiratory tract.

We’re now in this weird stage of the pandemic, where it feels like it’s over but it’s really not. Where do we go from here?

You know, one of the things that worries me is the evolution of the virus and the variants that are continuously emerging. If the future variants are very immune-evasive or pathogenic, we would have to think about how we are living these days. Many people have decided that Covid is over, and they’re just unmasking and not bothering to get vaccinated. That’s unfortunate, because I think those are the people that are going to be most vulnerable to a future wave of infection.

Are we ready for the next pandemic?

We’re still failing to respond appropriately to the current pandemic. People have this sort of pandemic fatigue. They’re just done with it, regardless of the risk that they’re facing. So if something were to hit right now, I’d be worried because people are intolerant to taking any more measures. And that is a perfect storm for the virus to spread and make people sick. So yes, I just hope we have some break.

Are you or others in the field worried about the spread of monkeypox? Could it ever become a massive worldwide problem like smallpox was?

I am not certain how effectively monkeypox can spread to become a massive pandemic like smallpox. If we can implement testing, isolation, contact tracing and vaccination measures quickly before that happens, a massive pandemic can be prevented.

Would nasal sprays work for monkeypox?

For monkeypox, the nasal cavity is not a major site of mucosal transmission. It may also be transmitted via broken skin, sexual contact or other routes. We’re still finding out how many ways this virus transmits. So I would not think a prime-and-spike type of vaccine is best for this virus.

https://www.quantamagazine.org/an-immunologist-fights-covid-with-tweets-and-a-nasal-spray-20220621/