Firefighters are making progress on containing the wildfires that have been raging for weeks in Southern California. But even once the physical threat of the fires diminishes, the mental-health toll will linger for months and even years, experts say. With thousands of people evacuated and homes destroyed, rebuilding people's social and psychological resources is one of the next pressing challenges. Mental-health crisis centers are already seeing a surge in wildfire-related calls from the Los Angeles area. Here's what experts say survivors can expect as they process their experiences, and the resources available to them. "A real intense sense of uncertainty" The national mental-health help line, 988, says they saw a five-fold increase in the number of calls to its associated Disaster Distress Helpline from the Los Angeles region from Jan. 7, when the fires began, to Jan. 15. “We did a brief analysis of what people are talking about, and the predominant emotions people are experiencing are fear, grief, and a real intense sense of uncertainty,” says Tia Dole, a psychologist and chief 988 suicide and crisis lifeline officer. “For California, this is the beginning of the wildfire season—this isn’t the end. So what’s going to happen next?” Dr. Shairi Turner, chief health officer at Crisis Text Line, a national mental-health support network that provides mostly text-based support and resources, says that texts from Los Angeles County have increased over the first few weeks of the year compared to the same time last year. Most of the discussions involved stress or anxiety. Counselors have been helping people struggling with the uncertainty of not knowing if they will be evacuated, feelings of isolation, and grief of losing their homes or having their lives interrupted with no practical plan for resuming daily activities. Some have also reported having difficulty with post-traumatic stress disorder (PTSD), as the current blazes trigger memories of previous fires and evacuations. The near-term emotional toll of wildfires “Typically in the beginning phases of a disaster, people are more focused on, ‘Do I have to evacuate? Where am I going? Has my house burned down?''” says Shari Sinwelski, vice president of crisis care at Didi Hirsch Mental Health Services in Los Angeles. But in the following weeks and months, "the focus is less on the physical and practical aspects of this disaster and more on how people are coping.” Those affected by the fires may have a range of feelings, which can also show up in physical symptoms like a racing heart or sweaty palms, says Jason Moser, professor of psychology, kinesiology, and neuroscience at Michigan State University. They may feel a jumble of emotions: stress, sadness, anxiety, anger, fear, and more. Read More: Can Hearing About Someone Else’s Problems Fix Your Own? Some of those emotions may lead people to question their future and their safety. “Some people may come out of the experience thinking the world is a much more dangerous place and find dangers lurking everywhere, which changes their mindset of whether it’s safe to live a normal life,” Moser says. Those emotions are normal, Moser says, and people should allow themselves to feel their full range in the days and weeks after the disaster. The importance of seeking support Anyone who feels like they need someone to talk to should reach out for help, experts say, but that doesn’t mean it needs to be professional help in the form of a therapist, psychologist. or psychiatrist. “Our main message is: seek support, whether that support is formal therapy, reaching out to friends or family members, or finding a group of people that have lived through a similar experience,” says Turner of Crisis Text Line. Having a robust social network makes a person less likely to develop PTSD. Even those with a support network may struggle to process the loss and fear that comes with surviving a wildfire, and may develop PTSD. “Something like 70% to 80% of people who experience trauma don’t go on to develop PTSD, and about 20% to 30% do,” says Justin Baker, assistant professor of psychiatry and behavioral health at The Ohio State University and clinical director of the Suicide and Trauma Reduction Initiative for Veterans. When it's time to enlist professional support In the days to weeks after wildfires, people are driven by a basic survival instinct that experts call the fight-or-flight response, which helps them become more focused and hyper-vigilant about their safety. This adrenalin-driven mental state should switch off as the threat diminishes, but in some people, it may not. “The trick is not to stay there,” says Baker. “Within a month or so, if symptoms like hypervigilance and nightmares persist and are interfering with your quality of life, your work or school, and the relationships with your family and friends, then that’s a good indicator that you should reach out to a professional or engage more intensively with family.” People stuck in this state may be experiencing a stress disorder. Read More: Why People Still Misunderstand Trauma Another rule of thumb is to assess whether you feel any different than you did on the day the trauma began, says Moser. “If after the first month you are more or less where you were emotionally at day one, then you might want to reach out to someone,” he says. Experts say professional interventions can include psychotherapy, cognitive behavioral therapy, and more. In PTSD treatment, for example, mental-health experts find ways to talk about and de-escalate the strong emotional responses people have to their experience, thus neutralizing them and decreasing their ability to cause anxiety. Other ways to start healing Staying connected to your social network can be very useful, say experts, although it’s important not to surround yourself with others who constantly ruminate on the disaster and its aftermath. “You don’t want to be on either extreme—you don’t want to not talk about [your experience,] and you don’t want to do nothing else but talk about it,” says Moser. Mindfulness techniques can also help. What will work best depends on the person. “There is no one-size-fits-all solution when it comes to managing emotional responses,” says Ethan Kross, professor of psychology and management and organizations at the University of Michigan and director of the Emotion and Self Control Lab. “Some people might benefit by interacting more in a social support network, which can help them to reframe things, where other people might benefit from cognitive strategies and looking at the big picture.” Getting back some semblance of a routine of eating, staying hydrating, and sleeping regularly may also help, says Moser, although doing so may be difficult in the early days. Read More: Changing Your Diet and Lifestyle May Slow Down Alzheimer’s Find ways to combat the negative thoughts and rumination that can take over—such as worrying about whether you have enough money to rebuild your home or whether or not government emergency funds will become available. Act on these worries where you can, says Moser, but since so much is out of any one person's control, "focus on the fact that you are safe.” Mental time travel is another strategy that he suggests. Imagine where you will be in a few months, such as in temporary housing, or living somewhere else, away from the threat and its constant reminders. People can also use a technique supported by research showing that people are better at giving advice to others than to themselves. Talking to yourself in the second or third person is a way to do this; you'll trick your brain into seeing things more objectively. “It sounds hokey, but we’ve done a ton of research that shows it works,” says Moser. “It takes the edge off and gets the brain to start giving yourself advice the same way you would give advice to somebody else.” The important thing, says Kross, is to give yourself time to feel your emotions first and not rush to “resolve” or ignore them. How to get immediate mental-health help 988 is the national number for those in crisis, and people can call, text, or chat with counselors. People can also text 741741 to the Crisis Text Line for text-based support. Local disaster and mental-health resources are also available. “We have very good treatments to help people get their lives back on track,” says Baker.

On his first day in office, President Donald Trump signed an executive order withdrawing the U.S. from the World Health Organization (WHO)—a move that experts say makes the U.S. and other countries less safe from infectious diseases and other public-health threats. “For Americans it may not be obvious immediately what the impact will be, but given the world we live in and all of the factors that are driving more disease outbreaks, America cannot fight them alone,” says Dr. Ashish Jha, dean of the school of public health at Brown University and former White House COVID-19 Response Coordinator. “We need an effective WHO to not just keep the world safe from these diseases, but to keep Americans safe from these diseases.” "The bottom line is that withdrawing from the WHO makes Americans and the world less safe," says Dr. Tom Frieden, president and CEO of the nonprofit health organization Resolve to Save Lives and former director of the U.S. Centers for Disease Control and Prevention (CDC). In a statement responding to Trump’s order, the WHO says it “regrets” the U.S.’s decision. “We hope the United States will reconsider and we look forward to engaging in constructive dialogue to maintain the partnership between the USA and WHO, for the benefit of the health and well-being of millions of people around the globe.” Here's what to know about the U.S.'s withdrawal from the global health organization and what it might mean for the health of Americans and people around the world. The background This is the second time Trump has attempted to withdraw from the WHO. In 2020, during the pandemic and toward the end of his first term, Trump submitted a letter to the Secretary-General of the United Nations stating the U.S.’s intention to withdraw. Though U.S. funding stopped, a withdrawal didn't happen: About six months later, then-President Biden in his first day in office wrote back to the Secretary General saying that the U.S. would remain a member of the WHO. In the new executive order, Trump cites the WHO’s “mishandling of the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.” Trump, along with other public-health experts, have previously criticized the agency for not holding China more accountable for its slow response to the WHO's investigation of COVID-19's origins. Read More: The Health Risks and Benefits of Weight-Loss Drugs The order also says that the U.S.’s member dues—which ranged from $100 to $122 million over the past decade, the highest that any member pays—are “unfairly onerous” and “far out of proportion with other countries’ assessed payments." (By comparison, while China has a similar assessment, its population is four times the size of the U.S.) The U.S. also contributed far more in voluntary funding in recent years; in 2022-2023, for example, it provided a total of nearly $1.3 billion to the health agency. What happens next? In the WHO's agreement with the U.S., the U.S. would provide one year’s advance notice and pay any remaining balance to the organization in order to leave. But that agreement, made in 1948 when the WHO had just been created, was made through a joint act of Congress. It’s not clear whether Congress would have to act to implement the withdrawal. Lawrence Gostin, professor and chair of global health law at Georgetown University and director of the O’Neill Institute, says Trump’s decision may open him up to legal action. “Trump made a unilateral decision to pull out of WHO,” Gostin wrote on X. “But we joined WHO in 1948 by an act of Congress. Trump needs Congress’ approval to withdraw. As director of a WHO Center, I am considering a lawsuit.” Gostin also points out that the executive order calls for immediate cessation of payments, although the terms of the U.S.’s agreement with the WHO allows for a year to implement the withdrawal. What public-health experts are saying Experts are raising concerns about the short- and long-term implications for public health in the U.S. and abroad. “The WHO continues to serve as a very critical air traffic control and public health response organization for the world,” says Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We in the U.S. don’t experience many of the infectious diseases we see around the world in large part because they are stopped in these countries, oftentimes through the support and coordination of the WHO. Funding the WHO is about investing in our own health here in this country.” Read More: White House’s Pandemic Office, Busy With Bird Flu, May Shrink Under Trump The WHO is not without controversy. Some of its biggest supporters have also criticized the bureaucracy and inefficiencies of the organization. However, health experts largely don’t see withdrawing funding as an effective catalyst for change. “The WHO can be improved; there are inefficiencies, like with all organizations,” says Paul Spiegel, professor in the department of international health and director of the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health. “But by pulling out, and removing the huge amount of money that the U.S. gives, you’re not allowing the WHO to make reforms. You’re hobbling it.” What does the WHO do? With 194 member countries, the WHO is responsible for a number of important public health programs—particularly vaccines. Each year, scientists there, working with health officials around the world, determine which influenza and COVID-19 strains to include in updated versions of the respective shots. As a member, the U.S. has access to samples of these strains, which help vaccine-makers develop and produce enough doses of matched flu vaccines in time for flu season for the public each year. The WHO was instrumental in coordinating the eradication of smallpox and is now working to eliminate polio. Being part of the international network becomes critical when a new threat like COVID-19 emerges, Jha says. “When there are outbreaks, countries usually report them first to the WHO and share samples with the WHO,” he says. As a member, “the U.S. has access to that information"—but if the U.S. withdraws, "our ability to access all of that will substantially be worse.” Read More: The Virus Hunters Trying to Prevent the Next Pandemic The WHO also provides health guidance for a number of countries that don’t have the resources to create health recommendations for their populations, such as advice on breastfeeding, diabetes, and giving up smoking. While other non-government organizations and philanthropies exist, like the Global Fund and GAVI, “none has the same level of trusted relationships with the ministries of health in different countries that WHO has,” Jha says. Frieden agrees. "The executive order says the U.S. is looking for alternatives. But what alternative do we have that works with 194 countries and is trusted by them? If you look at the reach, the relationships, and infrastructure of the WHO, it's unparalleled." Have countries withdrawn from the WHO before? In 1949, a year after the WHO’s creation, the then Soviet Union and a number of satellite states in Eastern Europe withdrew as Cold War tensions mounted. However, they returned in 1956. Liechtenstein is the only country that is a member of the United Nations but not a member of the WHO. Are there signs that the WHO is reforming and changing in response to criticisms? “If I were giving a grade, I would say their reform efforts get a solid ‘C’,” says Jha. While he says the agency’s emergency preparedness response to outbreaks has improved, in his opinion the WHO still must address under-performing personnel and what he sees as a culture that isn't responsive enough to fast-moving pathogens. Jha and other public-health experts argue, for example, that the WHO acted too slowly in allowing the U.S.'s mpox vaccine to be made available to African countries during the recent mpox outbreak. Read More: What to Expect at Cataract Surgery “There is an arrogance there that even though the vaccine was approved by the FDA and EMA [European Medicines Agency], they wanted their own review because they don’t trust our regulators,” says Jha. “I’m sorry, but if both the FDA and EMA have approved it, then you can do a pretty rapid review and don’t need an independent year-and-a-half review." "But that’s classic WHO: they think they are better than everybody else when they actually are not," Jha says. "I think there are deep cultural issues that need addressing inside the WHO.” How a withdrawal could endanger the U.S. The most immediate domestic consequence may be that if the U.S. is not privy to the WHO’s database of changing influenza strains, more Americans could be hospitalized and die from flu infections, says Jha. “Right now 30,000 elderly people at high risk for influenza complications die every year from the flu," he says. "If we are not making vaccines, or our vaccines are not as good or effective, then we are going to see those numbers go up.” By not being a WHO member, the U.S. would also lose access to the global database of health information that includes surveillance for new and existing infectious diseases, which could make the country more vulnerable to microbial threats from around the world. “It means we are going to see a lot more disease outbreaks become regional and global, and we will see more disease outbreaks from other countries coming into the U.S.,” says Jha. Read More: How to Dress Warmly for Cold Weather, According to Science If the U.S. withdraws, there will also be implications beyond health. The U.S. would lose its major role as an influencer in global health policy; currently, it shapes how the world responds to and maintains people’s health, Osterholm says, in what he calls “public health diplomacy.” By supporting the WHO, the U.S. supports programs that bring clean water, food, and vaccines to children around the world, and in turn creates valuable relationships with countries that otherwise would be out of reach. “If we are not supporting or doing those things, wait to see how the Russians and the Chinese will,” he says. “They will fill in behind us, and we will absolutely lose the connections to some countries that have been valuable to us over recent decades.” The U.S.'s withdrawal would leave a sizable financial hole for the agency. “I don’t see other countries stepping up and filling the gap,” says Jha. "Except maybe one country that could do this, and that’s China. That alone would not be great for U.S. interests.” Soon after Trump stopped U.S. funding to WHO in 2020, China pledged $30 million to the organization. What the rest of the world risks Without U.S. membership, the WHO would lose its close ties to the CDC, which is regarded as one of the world’s leading public-health agencies. Several dozen CDC researchers are currently assigned to the WHO and would likely be recalled, experts say. Those scientists form critical bridges between the U.S. and other countries, allowing for the exchange of information on new and emerging threats as well as policies that promote health and prevent chronic diseases. Read More: When Should I Go to the Doctor With Cold Symptoms? For Frieden, that possibility hits close to home. Early in his career, while working for the CDC, he was assigned to work at WHO in India on its programs to control tuberculosis. "I couldn't have done what I did as a CDC employee," he says, noting that the non-political rubric of the WHO enabled him to travel throughout India, meet with high-level local officials, and implement programs to reduce the spread of drug-resistant tuberculosis that continues today. "There are a lot of places where as Americans we can't be—for safety reasons, for political reasons. And WHO provides that space where countries that may not agree on anything else can have a discussion." Smallpox, which required the U.S. and Soviet Union to work together through the WHO, was eradicated during the Cold War, he adds. Health threats around the world—not just from infectious diseases, but also urbanization and deforestation—are forecasted to increase due to climate change and other factors, says Spiegel. “Our interactions with animals are increasing, so the chances of some novel disease like COVID-19 probably increase compared to 100 years ago,” he says. That makes global collaboration on health "more important now than ever.” The WHO makes such collaboration possible, Frieden says, with the common goal of improving health. "What weakens WHO makes us all less safe," he says. "What strengthens WHO makes us more safe.

The U.S. Food and Drug Administration (FDA) banned the use of Red Dye No. 3 in food and ingested drugs on Wednesday, more than three decades after the agency prohibited it from being used in cosmetics because of possible cancer risks. Consumer advocates and dietitians applauded the FDA for the move, though many also said it was overdue. In 1990, the FDA barred the dye from being used in cosmetics and topical drugs after a study found that it caused cancer in male rats. For years, consumer and health advocates have pushed the agency to do the same for foods, since federal rules require the FDA to prohibit additives that have been found to cause cancer in animals or humans. Still, the FDA said in its announcement that the way Red 3 causes cancer in male rats “does not occur in humans,” and “studies in other animals and in humans did not show these effects; claims that the use of FD&C Red No. 3 in food and in ingested drugs puts people at risk are not supported by the available scientific information.” The FDA said food and drug manufacturers will have until Jan. 15, 2027 or Jan. 18, 2028, respectively, to remove the dye from their products, and although other countries still allow the dye to be used in certain products, all foods imported to the U.S. have to comply with the new requirement. Branded Content XPRIZE at the 2025 TIME100 Summit: Making the Impossible, Possible By XPRIZE Here’s what to know. What is Red 3 in? Red 3 is a synthetic colored dye that’s used to brighten the appearance of food products, giving it a vibrant red color, according to Brian Ronholm, the director of food policy for Consumer Reports. Ronholm says the dye doesn’t have any nutritional value, and is used purely for aesthetic purposes. While some food manufacturers stopped using the dye in their products years ago, Ronholm says it can still be found in some products, like candies and other snacks. Vanessa Rissetto, a registered dietitian and co-founder of clinical nutrition care company Culina Health, says the dye can also be found in some cereals and baked goods. What will companies replace Red 3 with? Ronholm says that many companies around the world have already started using alternatives to Red 3, such as beet extract or other natural substitutes. “That’s another frustrating piece of this, from a consumer perspective: Red Dye 3 is banned in other parts of the world, and so substitutes are already being used that are more natural, less toxic, and in a lot of cases, just as cost effective,” Ronholm says. “It’s frustrating to think that these food companies are making available these safer versions in other parts of the world, but the inferior versions remain for sale here in the U.S.” According to Sensient Food Colors, which manufactures food colors and flavors, other alternatives to Red 3 include carmine (which many may not know is made from insects) and pigments from purple sweet potato, radish, and red cabbage. Are other dyes safe? Ronholm says consumer advocates have concerns over other types of dyes, including Red 40, Yellow 5, Yellow 6, Blue 1, Blue 2, and Green 3—all of which California banned from the meals, drinks, and snacks served by public schools in Sept. 2024, over concerns that the six dyes are linked to health and behavioral problems in some children. The FDA hasn’t established a “causal link” between children’s consumption of the six dyes and behavioral effects, but recommended further research. The agency still permits the six dyes to be used in foods. “We’re hoping that this is just a first step for the FDA to be more focused on these synthetic food dyes and chemicals and additives,” Ronholm says. “This shouldn’t be a ‘standalone victory.’ It needs to be the first step in an extended process.

It’s normal to have anxiety about cataract surgery—and even postpone scheduling the procedure out of fear. But it shouldn’t be that way. Dr. Jeff Dello Russo, an ophthalmologist at Dello Russo Laser Vision and New Jersey Eye Center, recalls working with one patient who was “hesitant and nervous for months” before scheduling her surgery. For years, the 78-year-old had been struggling to drive at night, read books, and enjoy activities with her grandchildren. “Within 24 hours after her cataract procedure, she was thrilled to be able to read her morning paper without glasses and see her grandchildren’s faces more clearly than she had in years,” says Dello Russo. “Cataract surgery is life-changing.” “Many of my patients feel that their world is brighter, richer, and clearer after surgery,” echoes Dr. Danielle Trief, an associate professor of ophthalmology at Columbia University Irving Medical Center. A large portion even say that they see better than their children. “Sometimes they realize that their clothing or paint in their house is a different color than they thought,” she says. Those aren’t the only benefits: some studies have found lower risks of dementia and falling after cataract surgery. “I believe this is because patients are better able to navigate their world,” says Trief. Here’s what you should know about the outpatient procedure. Restoring a city’s charm Branded Content Restoring a city’s charm By China Daily What are cataracts? Your eyes act like a camera, taking pictures and sending them to your brain so that you can see. In the front of the eye, a lens brings images into focus onto the retina. “The lens typically is clear when we are born, but gets cloudy with time/age,” says Trief. As the lens fogs up, vision blurs, and this clouding of the lens is called a cataract. With cataracts, “often we have more glare in certain conditions,” Trief says, like driving at night or reading. The formation of cataracts is a natural part of aging. “Nearly everyone develops cataracts over time,” Trief says. Roughly 25 million Americans have cataracts, and more than half of people age 80 and above either currently have them or have had cataract surgery, per the U.S. National Institutes of Health. “Often they start to affect our vision in our 60s, 70s, or 80s, but sometimes earlier," Trief says. "We can sometimes initially adjust our glasses to improve vision, but ultimately the cataract becomes too cloudy, and the lens needs to be replaced.” How-cataract-surgery-works Graphic by TIME; Getty Images What is cataract surgery? Cataract surgery is designed to restore clear vision by removing the cloudy lens and replacing it with a transparent artificial lens. “This lens can correct the vision as well as provide more clarity, better contrast and less glare,” says Trief. And, adds Dello Russo, “if left untreated, cataracts can lead to significant vision impairment.” After the surgery, Trief says patients’ vision improves, and they are less reliant on glasses, though most people will still need glasses for some tasks, such as reading. Modern cataract surgery is one of the safest and most effective surgical procedures, says Dello Russo, with a 98% success rate. “Many people report that they wish they hadn’t waited so long to have the surgery,” he says. Complications include infection, retinal detachment, and loss of vision; it is estimated they occur in less than 2% of patients. How to prepare for cataract surgery Here are some of the key things you will be asked to do before undergoing the procedure, according to Dello Russo and Trief: Don’t apply sunscreen, makeup, or other skin-care products around your eyes the day of the surgery and a few days leading up to it to prevent any product from entering your eyes during the procedure. Your doctor will tell you if you need to pause any medications that may affect the surgery. In most cases, “I actually do not stop medicines before surgery,” says Trief. “It is a bloodless procedure, so I allow my patients to continue all blood thinners.” Use eye drops as directed. “Your doctor may ask you to use antibiotics or anti-inflammatory eye drops a few days before the procedure,” says Dello Russo. Follow your doctor’s advice about wearing contacts. Trief asks her patients to stop wearing soft contact lenses for one week prior to the pre-surgery measurements doctors take, since the lens can change the shape of the eye and affect the measurements. People who wear hard contact lenses should be out of lenses for two weeks. “Once measurements are taken, however, they can resume contact lenses until the time of surgery,” says Trief. What happens during cataract surgery Cataract surgery is an outpatient procedure that’s typically done in an ambulatory surgical center, though it may be done in a hospital setting. “The surgery should be very easy for the patient,” says Trief. Before your surgeon starts, your eyes will be dilated and examined, and an IV will be placed. Then, you’ll receive numbing eye drops or a local anesthetic to prevent discomfort. You may also be given a mild sedative to help you relax, says Dello Russo. You won’t be asleep during the procedure, but fear not: you won’t see the surgeon at work since they’ll be working under an operating microscope that prevents you from seeing the surgery take place. Read More: What to Expect at a Skin Cancer Screening “During the procedure, the surgeon uses a tiny incision to remove the cloudy lens and replaces it with an artificial intraocular lens,” Dello Russo says. He calls the surgery “painless”—though you might feel slight pressure or see bright lights during it. The procedure only takes about 10 to 30 minutes, and you’ll lie on your back with head support. (“Patients sometimes worry about moving,” says Trief.) Doctors only correct one eye per surgery in order to allow the surgeon to assess the outcome and fine-tune the approach for the second eye, which could potentially improve overall results. If you need the procedure in both eyes, there’s typically a wait-time between surgeries of a week to a month. A note about the different kinds of cataract surgery Cataract surgery can be done with or without laser assistance. Unlike traditional cataract surgery, which relies on manual incisions and ultrasonic tools, laser cataract surgery uses high-tech laser systems to perform many steps of the procedure, says Dello Russo. “The laser creates precise incisions in the eye and softens the cataract for removal, reducing the need for manual tools.” Dello Russo prefers laser surgery, saying that it minimizes stress on the eye, leading to faster recovery times and less discomfort. Read More: What to Expect at a Mammogram However, Trief cautions that the laser is usually not covered by insurance and has an out-of-pocket cost to the patient (even though cataract surgery itself is typically covered). This is because laser-assisted cataract surgery is considered an advanced technology that is not mandatory to complete the procedure, says Dello Russo. “Insurance may cover the standard procedure portion, but the patient may be responsible for the extra cost of the laser.” As always, check with your insurance provider to learn about your plan’s coverage. There are also many different lens implants available. Some correct for distance vision, some correct both near and distance vision (a multifocal lens), and others (toric lenses) correct astigmatism. “Cataract surgery used to be one-size-fits-all, but now with the lasers and our specialty lenses, we have many different options to customize for the patient’s preference,” says Trief. She encourages people to read about their options and consult with their doctor about what makes the most sense for them. What to expect after cataract surgery “Many patients notice significantly clearer vision within 24–48 hours, although full recovery can take a few weeks,” says Dello Russo. Some may have blurry vision for the first few days or weeks after surgery, but it typically clears quickly. After surgery, doctors will send you home with an eye cover, and you’ll return for a follow-up appointment the next day. Because of the eye patch and sedation, patients will need to arrange for a ride home. “Most of my patients take a few days off from work, but some go back to work the next day,” says Dello Russo. As for post-op pain, you shouldn’t feel much, if any. Sometimes patients feel itchiness, scratchiness, or like something is stuck in their eye. “It often feels better the next day,” Trief says. Read More: Is Intermittent Fasting Good or Bad for You? According to Trief, most people resume their normal lives in the days following surgery: you can read, meet up with friends, and even work, as long as it does not involve physical exertion. (Typically, the eye patch will be removed the day after surgery, but you’ll continue sleeping with it for a week.) You may also have some light sensitivity after the procedure, but if it does not hurt your eyes to use the computer or read, you can do so, says Trief. She asks patients not to do any exercise or bend their head below their waist for one week after surgery. In general, Dello Russo says light activity is fine within a day or two, but you should avoid strenuous activities for at least a week. Your doctor will direct you to use eye drops after surgery. How often you’ll need them varies by the person and the type of drops prescribed, whether they’re lubricating, antibiotic, steroidal, or nonsteroidal anti-inflammatory. “Typically, patients will need to use several different types of eye drops multiple times a day for a few weeks after surgery,” says Dello Russo. The amount of time you’ll use eye drops varies, too, but expect to use them for about a month after surgery. More in Health The Scientific Search for Youth Why Do I Keep Having Recurring Dreams? Dermatologists Have a Dirty Little Secret The Best Longevity Habit You’re Not Thinking About Personal Trainers Share the No. 1 Tip That Has Changed Their Lives In terms of follow-up visits, patients are seen the day after the procedure and again within one to two weeks. You may also return to your ophthalmologist’s office for a final check-up in a month. “I typically do the two eyes two weeks apart, and a few weeks after their second eye has surgery, they will get their final visual prescription,” says Trief. Patients can also wear an updated contact lens prescription after cataract surgery once you’re done with your post-op eye drops protocol. If you’re still anxious For nervous patients, Dello Russo and Trief have some more reassurance to share. For one thing, it’s a resoundingly safe procedure that truly improves people’s quality of life and fosters independence as people age. Trief stresses that it’s one of the few surgeries where people notice a big benefit almost right away, and that it’s a quick procedure without much downtime. Along with the many technological and safety advances in this surgery, there have also been innovations in its ability to not only restore vision but also to reduce dependency on glasses following the procedure. And if the idea of being awake during surgery is the part that scares you, Trief gets it—but says you’ll be provided enough anesthesia to feel comfortable. As a bonus? “Some people remark that they enjoyed the experience and see pretty colors,” she says.

If you’ve ever experienced irregular bowel movements during your period, you’re not alone. Your menstrual cycle can lead to symptoms like bloating, cramping, and changes in your bowel movements. Many people experience diarrhea while on their period (commonly known as “period poops”). We spoke to doctors about what causes the phenomenon and how best to manage stomach-related issues associated with your menstrual cycle. What causes “period poops”? In the week or two leading up to your period, it’s not uncommon to experience constipation and bloating. That’s because your body is releasing more progesterone (in preparation for a possible pregnancy), which can relax your gut muscles so your gastrointestinal system "doesn't move things along as quickly,” says Dr. Wendi LeBrett, a gastroenterologist in Idaho. But when you start your period, your progesterone levels drop. “I describe this as taking the brakes off,” LeBrett says. “Then, all of a sudden, whatever’s been slowing down your gut is gone, and so then there’s an increase in gut motility.” @socalgastrodoc Who else can relate to period poops 🩸 💩 ?? It’s more common than you think and can contribute to cramping around the menstrual cycle #periodpoops #pooptok #hormones #periods #motility #lutealphase #guthealth #womenshealth ♬ original sound - socalgastrodoc At the same time, your body produces more hormone-like substances called prostaglandins while you’re on your period, according to LeBrett. Prostaglandins cause uterine contractions during menstruation, which helps shed your uterine lining and can cause cramps. But prostaglandins can also cause the contraction and relaxation of your gut muscles, LeBrett says. That can cause more frequent bowel movements and loose stool or diarrhea, says Dr. Karen Tang, a gynecologist and the author of It’s Not Hysteria, a book about reproductive health. How can you ease stomach problems associated with your period? If you’re constipated before your period starts, LeBrett recommends eating insoluble fibers, like the kind found in leafy green vegetables. If you start having diarrhea during your period, she suggests eating soluble fibers, like the kind found in bananas and oatmeal. Some fruits and vegetables contain both types of fibers. Ibuprofen is a prostaglandin inhibitor, so it can help ease the discomfort of both period cramping and irregular bowel movements, LeBrett says. But LeBrett advises people not to take it too frequently or on an empty stomach, since ibuprofen can increase the risk of stomach ulcers. So are “period poops” normal? Yes. But both LeBrett and Tang say that if your symptoms are severe, you should see a doctor. “I usually say, if something’s affecting your quality of life, that’s not normal,” Tang says. @karentangmd #stitch with @hayleygeorgiamorris WTF are #periodpoops ?! #periodpoop #endometriosis ♬ original sound - KarenTangMD If you’re experiencing severe diarrhea, if it hurts to have bowel movements, or if there’s blood in your stool, Tang recommends consulting your doctor. More serious symptoms could be a sign of another condition, like endometriosis or a gastrointestinal issue. “If you’re noticing [period poops] cyclically, like it always happens around your period, that kind of fits with the overall changes in your menstrual cycle,” LeBrett says. “If you’re noticing it more chronically, like you’re always having diarrhea, and it’s maybe a little worse during your period, but you’re still having diarrhea on the other days of your menstrual cycle, that’s another time to discuss with a doctor.”

Processed red meats—like bacon, deli meats, and hot dogs—are linked to a host of health ills. Now, the latest study finds that eating too much red meat may even harm the brain. In a study published in the journal Neurology, Dr. Daniel Wang, an assistant professor of medicine at the Brigham and Women’s Hospital and Harvard Medical School, and his team report that people who eat more processed red meat had a 14% higher risk of developing dementia over more than four decades that those who consumed minimal amounts. The study analyzed data from more than 130,000 health professionals enrolled in two major studies: the Nurses' Health Study and the Health Professionals Follow-Up Study. Every two to four years, people filled out detailed dietary surveys asking about their intake of more than 150 foods. The researchers also collected health data on dementia diagnoses and asked people brief questions about their memory. “Based on this data, we see that if people have higher processed red meat intake, they have a higher risk of dementia, a higher risk of subjective cognitive decline, and worse cognitive function,” says Wang. The scientists saw increased risk of all of these outcomes with any consumption of processed red meat, and it continued to increase the more meat a person consumed. The 14% increased dementia risk was the upper threshold. It didn't take much meat to reach that upper limit. The 14% higher risk of dementia was linked to people who ate at least a quarter of a single 3-oz. serving of processed red meat daily—equivalent to two slices of bacon, one and a half slices of bologna, or a hot dog—compared to those who ate less than a tenth of a serving (less than a slice of bacon) a day. Read More: Why Are So Many Young People Getting Cancer? It’s Complicated Wang plans to keep studying these populations to better understand how processed red meat affects the brain, and possibly dementia. One theory is that processed meat, because of its high saturated fat and sodium, can increase the risk of diabetes and heart conditions, in part by raising blood pressure, and thus harming the brain. Another is based on the fact that that some of the compounds the body makes when it breaks down processed red meat can increase the risk of dementia; in the lab, for example, some of these compounds cause the clumping of amyloid protein that is a hallmark of Alzheimer’s disease. Finally, the nitrites found in processed red meats may damage DNA, injuring brain cells. More in Health The Scientific Search for Youth Why Do I Keep Having Recurring Dreams? Dermatologists Have a Dirty Little Secret The Best Longevity Habit You’re Not Thinking About Personal Trainers Share the No. 1 Tip That Has Changed Their Lives Previous studies of processed red meat and dementia have been inconsistent, with some finding a connection and others not. Wang says those studies were smaller and followed people for less time, without evaluating people's diets more than once. His team's approach, on the other hand, “captured changes in dietary intake during decades-long follow up, which is the strength our study has,” he says. The detailed dietary data also allowed them to estimate what effect replacing red meat would have on dementia risk. Substituting one serving a day of processed red meat with nuts or legumes contributed to a 19% lower risk of dementia over the study period; similarly, replacing red meat with fish was linked to a 28% lower risk of dementia. Eating chicken instead of red meat for one serving daily contributed to a 16% lower dementia risk. Read More: 9 Things You Should Do for Your Brain Health Every Day, According to Neurologists The data also allowed Wang’s team to compare people who ate more processed red meat to those who ate more unprocessed red meat. Those who ate more unprocessed red meat did show a slightly higher risk of dementia compared to people eating minimal amounts, but this association wasn’t statistically significant. However, on the scale that measured people’s own assessments of their cognitive function, those who ate unprocessed red meat had a 16% higher risk of having memory issues than those who ate minimal amounts. This subjective assessment included six to seven yes-or-no questions, including whether they had more difficulty remembering the names of close friends in the past year compared to the previous year, or whether they had problems finding their way home in the past year.

Forget catching big air on the ski slope or staying upright on an ice rink. If there’s any such thing as a winter superpower, it’s knowing how to dress to stay warm. “When we dress appropriately, it allows us to enjoy the outside weather,” says Dr. Cheyenne Falat, assistant medical director of the adult emergency department at the University of Maryland Medical Center, who specializes in environmental emergency medicine. “But beyond just comfort and being able to enjoy activities outside, there are very serious health risks if your body fails to stay warm.” The most sinister threat is hypothermia, which occurs when the body loses heat faster than it can produce it, leading to up to 1,500 deaths in the U.S. each year. Falat has also treated lots of patients who experience cold-weather injuries like frostbite, which can cause significant pain, skin blisters, or complete freezing of a body part. The worst cases—when your body’s tissue loses its blood supply—require amputation, she says. Plus, winter weather can lead to heart problems, trigger asthma attacks, and spike blood sugar levels, among other potential hazards. Dressing appropriately can help insulate you from the elements and create a “microclimate” says John Castellani, a research physiologist with the U.S. Army Research Institute of Environmental Medicine. The goal is to feel slightly cool, but not cold—so when you start moving around, you won't get too sweaty and uncomfortable. “You want to feel the same way you would if you were in your house and had the temperature at 70°F,” he says. That will help you fend off potential health threats and make winter more palatable. We asked experts to share the best science-backed ways to dress during the winter to keep your whole body warm. What to look for in winter gear The two most important properties to look for in cold-weather gear are thermal insulation and wind resistance, says Khubab Shaker, chairman of the department of materials at the National Textile University in Pakistan. “Clothing with high thermal insulation keeps you warm by trapping heat inside it,” says Shaker, who has researched the subject, “while wind resistance helps block wind and protect from its chilling effect.” There’s a fancy formula that experts like Shaker use to calculate thermal insulation, but the average shopper can simply check labels and closely examine the product to predict how warm it’ll be. Does that shirt you might wear hiking have a thick fleece lining? Does your potential jacket have multiple layers and a down fill power somewhere between 500 and 900? All are indicators that the product has good insulation. Read More: The Psychology of the Cold-Weather Shorts Guy It’s also important to make sure your clothing is moisture-wicking (meaning it draws sweat away from the skin and into the outer layer of your clothes, so it can evaporate) and breathable (allowing vapor to escape back into the environment, so you don’t start to feel sticky). That’s why wool rules: “It provides excellent insulation, resists odors naturally, and regulates temperature well,” Shaker says. It’s also fire resistant. The main drawbacks, he says, are itchiness and, sometimes, a heftier price than other materials. Merino wool isn’t as itchy, but it can be even pricier. On the flipside, there are several materials he recommends avoiding. Plant fibers like cotton and linen are a poor choice for cold weather, Shaker says: “They have a tendency to absorb moisture and lose their insulating properties when they get wet.” Silk has the same limitations, while denim—despite its durability and the fact that it seems like it should be warm—is heavy, takes forever to dry, and provides inadequate insulation. The best way to layer Layering is essential on cold days—but you need the right technique. Fabrics like polyester, nylon, and wool work nicely for the base layer, which is closest to your skin, since they’re moisture-wicking and breathable. “When you sweat, it should take that sweat and pull it away from your body, so your body doesn't cool by evaporation,” Falat says. The second layer is all about insulation, which is where you get most of your warmth. Falat recommends opting for wool or fleece. Cashmere also does the trick. “These are all materials that trap air,” she says. “Air is a very poor conductor of heat, so if you trap these micro-pockets of air in between your base layer and outer layer, that will prevent heat loss away from the body, and allow you to keep that trapped warm air around you.” Your top layer, meanwhile—usually a jacket—ought to have a windproof or waterproof shell, typically made out of tightly woven synthetic fibers like polyester or nylon, as well as a layer of insulation. Its job is to create a barrier against the wind, reduce heat loss, and protect you from rain, snow, or whatever else the environment hurls at you. “The outer shell helps those inner layers stay dry and allows them to keep insulating you,” Falat says. Torn between down and synthetic insulation? There are pros and cons to each: Down (made out of the soft undercoat of feathers from waterfowl, like geese or ducks) is highly compressible and lightweight; however, it tends to be on the pricier side and requires careful cleaning, or the material will degrade with use. Synthetic insulation, meanwhile, is great for damp conditions since it dries quickly, and it’s less expensive and easier to care for. Though research suggests it provides a warmth-to-weight ratio comparable to down, it can be heavier and bulkier, which is why some people don’t prefer it. You’ll do fine opting for whichever you find most comfortable, experts agree. Read More: Why People Love Snow So Much Falat gravitates toward natural materials like goose down, but that's based on personal preference rather than science. “If someone is planning on doing manual labor outside or outdoor activities, and they’re going to repeatedly get dirty, then maybe synthetic material is a better choice,” she says. Her ski jacket, for example, has synthetic insulation—and it keeps her as warm as she could hope. “But I do have a few down jackets I use more for walking in town and just enjoying myself outside, and doing non-physical activities,” she says. If you’re spending an active day outdoors—hiking or skiing or shoveling mountains of snow—keep in mind that the goal is to be able to easily add and shed layers. Otherwise, if sweat dries on your body, it will remove heat, which could make your body temperature plummet before you even realize what’s happening. “The last thing you want to do is truly get very sweaty in the afternoon, and then have those colder, sweatier layers still on as it starts to get colder again,” Falat says. “We often see people suffering from mild to moderate hypothermia because they do some activities and sweat during the day, and then those layers cool them.” The more layers you wear, the more versatility you have, which heightens your ability to adapt. If the sun is shining while Falat is skiing, for example, and it’s not windy or wet out, she often tosses her outer shell into a backpack, and then puts it back on when it gets colder. Or, if it's relatively warm but windy and rainy, she’ll shed her mid layer—ensuring she doesn’t get too hot—before reuniting with it when the temperature drops. Ideally, you’ll have a friend with you whenever you’re spending a lot of time outside in winter weather, Falat adds. That way, you can keep an eye on how the other person is responding to the temperature. Some people with hypothermia experience "paradoxical undressing,” which refers to a false sense of warmth that leads them to remove layers of clothes—worsening their condition. “I'm all about shedding that mid layer if you need to, if it's 35° and sunny outside,” she says. “But maybe have someone remind you, ‘Hey, it's 20° degrees, and it's cloudy and overcast and rain is coming. Maybe it's not the time to start undressing.’” How to accessorize well Your head is one of the fastest ways you lose body heat. To prevent that, opt for a hat made from wool, fleece, or acrylic—all of which offer excellent insulation—and make sure it has a snug fit. Or, if it’s especially cold, consider a balaclava that covers much of your cheeks, nose, chin, and neck. If you're planning to be active, your forehead and scalp might start sweating, in which case a headband that covers your ears can work well, Castellani says. “That gives you a place to get rid of some of the heat,” he notes. “Then you won't be sweating in your hat.” The best way to warm up cold hands is to be physically active, Castellani says. In general, though, he recommends opting for mittens over gloves: “Gloves protect your hands and reduce heat loss, but it’s with your fingers separated,” he says. “There's a lot of area of skin that radiates out to the environment.” Separated fingers get rid of heat faster than the alternative, he adds; if you're wearing mittens, your fingers will be pressed together, and that facilitates warmth. A bonus tip: Castellani likes balling his hands into a fist inside his mittens. “I’m basically reducing the area of heat loss within that protection,” he says. Read More: 9 Ways to Embrace Winter—Even if You Think You Hate It Don’t forget about your feet, either. Falat recommends socks made out of a wool blend (natural wool blended with stretchy synthetic fibers, like polyester and nylon), which has moisture-wicking properties in addition to providing warmth. Your feet won’t sweat in your shoes, but they’ll stay nice and warm, she says. She always carries an extra pair with her, so if her feet get wet, she can sub in the backups. And make sure your shoes are waterproof and wind resistant. “It's not the time to be wearing your Crocs or cotton tennis shoes,” she says. Pull them out of your closet again in the spring—a reward for making it through the winter thanks to the warmest possible wardrobe.

It’s not easy to become a taxi driver in London. Since 1865, to operate a taxi, drivers have had to pass what’s known as “the Knowledge,” a grueling test of a person’s memory of the thousands of streets, landmarks, and driving routes within the city. Students typically study for years to prepare for the Knowledge test, which is considered one of the most difficult examinations a human being can undertake. The end result is London claiming, with good reason, “the best and most qualified cabbies in the world.” Some London neuroscientists saw in cab drivers an opportunity to study how the brain might change in response to the heavy demand for navigational and spatial memory. In a famous study published in 2000, a group of 16 London cabbies underwent MRI brain scans, which showed that compared to people with other jobs, the cabbies had changes in their hippocampus: the brain region dedicated to memory and navigation. The more years people spent on the job, the larger their hippocampus. The hippocampus is a part of the brain implicated in the development of Alzheimer’s disease, the most common form of dementia, which primarily affects the elderly and results in memory loss and navigational difficulties, among other symptoms. The study of London cabbies thus begged the question: might taxi drivers be more protected from developing Alzheimer’s disease than the average person? With an aging global population, rates of Alzheimer’s disease on the rise, high costs of care for those with dementia, and an unpromising landscape for effective drugs, questions of how to prevent or slow progression of the disease are important for all of us—not just taxi drivers. Enterprises eye China’s huge consumer market Branded Content Enterprises eye China’s huge consumer market By China Daily Read More: 9 Things You Should Do for Your Brain Health Every Day, According to Neurologists In a new study published in The BMJ, we and our colleagues Vishal Patel and Michael Liu, also at Harvard, set out to study rates of Alzheimer’s deaths among taxi drivers and ambulance drivers, who rely on their memory to navigate on the fly. We did so by taking advantage of newly available data linking death records of Americans to their occupation. In addition to studying Alzheimer’s deaths among taxi drivers and ambulance drivers, we looked at bus drivers, ship captains, and aircraft pilots: jobs that, while transportation-based, require people to mostly stick to a predetermined route, which might not lead to the same kind of changes in the hippocampus. For more than 400 occupations, we measured the rate of death from Alzheimer’s disease. Importantly, we accounted for the age at which someone died. Alzheimer’s is predominantly a disease of old age, which means that occupations with lower life expectancies would be anticipated to have fewer Alzheimer’s related deaths, simply because people may not live to be old enough to develop the disease. Our findings surprised us. We found that the two occupations with the lowest rate of Alzheimer’s death among all occupations studied were taxi drivers and ambulance drivers. Taken together, their risk of dying from Alzheimer’s disease was 56% lower than the general population at any given age. Taxi and ambulance drivers did not have lower rates of death from other forms of dementia for which the hippocampus may be less involved. Read More: These Are the Best Ways to Improve Your Memory In addition, bus drivers, aircraft pilots, and ship captains—the jobs with less spontaneous decision-making—had Alzheimer’s death rates typical of the rest of the population. This suggests that routine navigation along highly frequented routes might not act on the brain the same way. In fact, a 2006 follow-up study by the London researchers of both taxi and bus drivers found that years of experience led to enlargement of the hippocampus in taxi drivers, but not bus drivers. While striking, our study is unable to establish that driving a taxi itself causes reduced rates of death from Alzheimer’s disease—it simply establishes a link, albeit a highly curious one. It may be, for example, that taxi and ambulance driving attract people who have naturally different hippocampi or have lower baseline risk of Alzheimer’s disease to begin with. After all, one might need a good memory to pass the Knowledge exam or make a career of driving a taxi or ambulance in traffic-ridden cities. We don't think this explanation is likely to explain the entire difference, however. Taxi drivers, for example, have lower life expectancy than most other occupations, and particularly good memory early in one’s life might be expected to be positively correlated with education, lifetime income, and life expectancy. Although our study and the London cabbies study raise more questions than they answer, they point to avenues for research into Alzheimer’s disease prevention. In the absence of highly effective treatments for Alzheimer’s disease, are there changes we could make to our daily lives to help reduce our risk? After all, the human brain is “plastic”: it adapts to the demands placed on it, which is how we are able to learn. Could we also force our brains to make adaptations that lower the risk for Alzheimer’s disease? Read More: You Can Now Treat Depression With an App We don’t know the answer to this question, but our study raises this as a hypothesis. You might wonder: what if we stopped using GPS navigation in our cars, forcing us to rely more heavily on memory to get around? Or more generally, might other cognitive activities that focus on improving navigational and spatial memory help? Current research suggests there may be some cognitive activities, like games and simulations, that could help slow cognitive decline in the elderly, and research is ongoing. But many studies—even high-quality randomized trials—will inevitably fall short because no short-term intervention could possibly replicate the brain changes that may be brought on by a career where navigational and spatial memory are as important as they are in taxi or ambulance driving. Despite the claims of various smartphone games, there’s no activity that, if done over a lifetime, has been shown to reduce the risk of Alzheimer’s. Confronting Alzheimer’s disease and other forms of dementia is a pressing public-health priority, both in the U.S. and abroad. The past several decades have seen a rapid expansion in the research community’s understanding of the brain and dementia, but highly effective treatments or prevention strategies for Alzheimer’s disease remain elusive. We don’t know yet whether deleting your map apps does your brain any favors. But, as we’re learning from cabbies, it probably won’t hurt to flex your brain’s navigation muscles a little more—and maybe let yourself get lost every now and then.

In late 2022, Erin, a 43-year-old from Pennsylvania, agreed to spend six weeks in a psychiatric ward, getting intensive treatment for an illness she knew she didn’t have. That decision was a last resort for Erin, who asked to be identified only by her first name for privacy. Her health had deteriorated after she caught COVID-19 nearly a year earlier; the virus left her with pain, fatigue, rapid weight loss, digestive problems, and vertigo. After another bout with a virus months later, Erin only got sicker, developing heart palpitations, muscle spasms, hoarseness, and pain in her neck, throat, and chest. Erin was no stranger to chronic illness, having coped with a connective-tissue disorder her whole life. This was different. She became unable to work and rarely left her home. Her usual doctors were stumped; others said her litany of symptoms could be manifestations of anxiety. When it became too painful to eat and swallow, Erin grew severely malnourished and was hospitalized at a large academic medical center. “I felt at the time like this was my last hope,” says Erin, who has since been diagnosed with Long COVID. “If I didn’t get any answers there, I didn’t know where to go afterward.” Grottoes bear the enduring touch of Tang Branded Content Grottoes bear the enduring touch of Tang By China Daily Once again, however, she was disappointed. The only physical diagnosis her doctors landed on was vocal-cord dysfunction, which Erin felt did not explain her wide range of symptoms. When her doctors began to discuss discharging her, Erin panicked and said she could not manage her excruciating symptoms at home—a sentiment that she says contributed to concerns of self-harm among her doctors and kicked off conversations about a stay in the psychiatric ward. Eventually, seeing no other way forward, Erin agreed to go. “I just got increasingly defeated over time,” she says. “I didn’t know what to do.” She was admitted for a six-week stay and given diagnoses she knew were wrong: an eating disorder and anxiety. Read More: Long COVID Doesn’t Always Look Like You Think It Does The vast majority of Long COVID patients will not land in psychiatric wards, but Erin is far from the only one who has. “Emergency rooms are dangerous places for people with Long COVID,” says David Putrino, who studies and treats the condition as director of rehabilitation innovation for the Mount Sinai Health System in New York. Numerous patients, he says, are told that inpatient mental-health care is their best or only option. He has worked with at least five patients who were ultimately admitted—and says some of his patients’ stories sound a lot like Erin’s. “Imagine you go to an emergency department, you wait 13 or 14 hours, your condition actually deteriorates, and then you’re told, ‘Hey, good news, everything is normal and we’re sending you home,’” Putrino says. “Going home doesn’t sound like a survivable outcome. So at that point you might break down...and often that gets reinterpreted as ‘Let’s put this person on a psych hold.’” Such experiences fit into a long, troubling tradition in medicine. Because there often aren’t conclusive tests for these types of complex chronic conditions, and because many patients do not outwardly appear unwell, they’re frequently told that they aren’t physically sick at all—that symptoms are all in their heads. “Mainstream medicine really isn’t geared toward treating conditions and diseases that it cannot see under a microscope,” says Larry Au, an assistant professor of sociology at the City College of New York who has studied one of the consequences of that disconnect: medical gaslighting of Long COVID patients. The chronic illnesses that make doctors doubt their patients often start after what “should” be a short-lived sickness. And it’s not just COVID-19; many diseases, from Lyme to mono to the flu, can lead to mysterious, lingering symptoms that are often ruinous but difficult to explain. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), for example, can follow a variety of viral or bacterial infections, leading to cognitive problems and extreme fatigue made worse by physical or mental exertion. (There is so much overlap between the symptoms of Long COVID and ME/CFS that many people now meet diagnostic criteria for both.) Today, the U.S. Centers for Disease Control and Prevention (CDC) calls ME/CFS a “serious, debilitating” biological illness—but for decades, it was written off as psychosomatic. A 1988 paper by researchers from the U.S. National Institutes of Health (NIH) suggested that it could be related to “unachievable ambition” and “poor coping skills.” And in 1996, a CDC researcher told a journalist that the condition has no viral cause, results in no immune abnormalities, and could be summed up as “hysteria.” Because the disease was for so long dismissed as psychological, many clinicians to this day try treatments like cognitive behavioral therapy that, at best, do nothing to address the condition’s physical symptoms—and, at worst, exacerbate them. Elizabeth Knights, who is 40 and lives in Massachusetts, went through even more intensive mental-health treatment. She spent several weeks in a psychiatric ward in 2006 before finally being diagnosed with ME/CFS and finding care that dramatically improved her health. During her senior year of high school, Knights caught a mono-like illness that never fully went away. Once at the top of her academic class and an avid skier and rock climber, Knights eventually had to withdraw from college and move in with her parents because she couldn’t function under the strain of persistent fatigue, flulike symptoms, and cognitive dysfunction—all of which her doctors chalked up to depression. “I kept insisting, ‘There’s something else going on here,’” Knights remembers. But she didn’t know about ME/CFS at that time, and her doctors were adamant that her problems were psychological. So when physicians recommended she try inpatient psychiatric care, she went along with it. “That was the only path that was presented to me,” Knights remembers, and she took it. Read More: The Relentless Cost of Chronic Diseases The experience made things worse. She was given numerous medications to which she had bad reactions and went through electroconvulsive therapy, which she says damaged her memory to the point that she had to relearn how to talk and navigate her hometown. “Nobody was listening to me, and people were not informed enough to make a correct diagnosis,” she says. “I was being misdiagnosed and treated for something that I didn’t have.” Rivka Solomon, a longtime ME/CFS patient advocate, says she hears this story a couple times a year: a patient, like Knights, has been wrongly admitted to or threatened with inpatient psychiatric care. And those are just the instances she learns about. “I worry about who is, right now, lying in a bed in a psych ward, too sick to function, left with no one to properly care for them, left with no one to advocate for them,” she says. Erin’s hospitalization left her with medical trauma that required therapy Erin’s hospitalization left her with medical trauma that required therapyLauren Lancaster for TIME The problem is larger than individual doctors, says Mount Sinai’s Putrino. People with conditions like Long COVID and ME/CFS may benefit from inpatient rehabilitative care, for example—but if they don’t meet admission criteria set by hospitals, state regulatory boards, or insurance plans, even well-meaning clinicians may be stuck. Sometimes, “there’s no administrative way to admit these people,” Putrino says. A psychiatric diagnosis is, in some cases, the simplest way to get a patient in. Another complicating factor: there is no validated medical test for detecting Long COVID, ME/CFS, or similar conditions like chronic Lyme disease, another post-infection illness that remains controversial. Although studies have identified biological signs of these illnesses, researchers have not yet found clear biomarkers that lead to definitive diagnoses. “The medical profession loves cold, hard diagnostic tools and evidence-based medicine. They want randomized controlled trials and an easy test that tells you yes or no,” says Dr. Monica Verduzco-Gutierrez, who runs a Long COVID clinic and is chair of physical medicine and rehabilitation at the University of Texas Health Science Center at San Antonio. When those tools aren’t available, clinicians sometimes deem patients’ symptoms psychological. Ruth, a 32-year-old who asked to use only her first name for privacy, recently had that experience, even though she is a mental-health professional herself and already knew she had Long COVID. One morning in 2024, she woke up in pain, struggling to breathe and unable to control her bladder. When she visited an emergency room, hoping for medication that might help, she says she was told by a doctor that she was experiencing anxiety. “I was like, ‘I am fading away here. I am slowly dying. I need help,’” she says. But despite her repeated requests for care and her own psychological training, she says she was turned away. These dismissals can also be damaging, Solomon says. “The extreme examples of patients being admitted to psych hospitals are just the tragic tip of the iceberg,” she says. Patients who aren’t believed may struggle to get any medical care at all, or get pushed toward therapies that don’t work. They may also face an uphill battle when trying to secure insurance coverage for treatments, disability benefits, or workplace accommodations. Read More: Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout Without the backing of a doctor or diagnosis, patients often find that other people in their lives don’t believe them, either. Doug Gross, chair of the department of physical therapy at the University of Alberta, has studied how hard it is for Long COVID patients to find medical care. He says patients often talk about “disbelief from not only the health care system...but more broadly in their social sphere: family members, employers, supervisors at work.” Psychiatric care is not always inappropriate for patients with Long COVID or similar conditions, Verduzco-Gutierrez says. Some do develop depression, anxiety, and other mental-health symptoms, potentially including severe neuropsychiatric complications related to inflammation in their brains or other physiological issues, Putrino says. “Some folks can really benefit from skilled psychological care, even if it’s not their primary or underlying, driving cause of their illness,” he says. Some clinicians, however, fail to differentiate between side effects and root causes, or use screening techniques that aren’t well suited for people with chronic conditions, Verduzco-Gutierrez says. For example, asking someone whether they struggle to get out of bed in the morning—a common question when screening for depression—isn’t all that useful if the clinician doesn’t differentiate between physical and mental exhaustion. “The only way to solve this is more education,” Putrino says, “so the next generation of clinicians are not looking at these patients and saying, ‘A couple of antidepressants and a day off will fix you.’” Katiana Mekka, a 26-year-old Long COVID patient from Greece, says education is especially needed outside the U.S. Last fall, she says, she was involuntarily committed to a psychiatric ward and held for three days, until she passed a thorough screening test for mental-health disorders. The ordeal worsened her already severe illness, leaving her virtually unable to eat, move, or talk for days after. “These illnesses are so mistreated and misdiagnosed,” Mekka says, adding that so few doctors in Greece know about Long COVID that she has been forced to seek virtual support from specialists in other countries. “The patients that I know, we all have so much will to live and so many dreams. This is not a mental issue. We have severe symptoms.” Read More: 11 Ways to Respond When Someone Insults a Loved One’s Disability There are signs that the medical community might be getting better at treating people with Long COVID and diseases like it. The sheer volume of Long COVID patients who have emerged in the wake of the pandemic—nearly 20% of U.S. adults have experienced symptoms at some point—has forced a reckoning with the medical system’s history and sparked new research interest in these conditions. The federal government now has an office dedicated to Long COVID research, and the NIH earmarked an estimated $110 million for Long COVID research in 2024. (Federal research funding for ME/CFS is still paltry in comparison: an estimated $13 million in 2024.) Solomon says more research on not just Long COVID but all infection-associated illnesses is critical, so scientists can develop reliable tests and effective treatments. There’s a long way to go. Putrino says he’s been advocating for systemic changes that would make it easier for hospitals to admit patients with complex conditions and for patients to secure reimbursement for in-home care, but progress is slow. Stigma and denial also still persist. And to this day, most U.S. medical schools do not teach trainee doctors about conditions like ME/CFS. Despite all she’s been through, Erin, the Long COVID patient who spent time in a U.S. mental hospital, considers herself lucky. She found a silver lining to her stay: in the psychiatric ward, she met a clinician—a speech pathologist she saw because of her vocal dysfunction—who knew about Long COVID and referred her to a specialist. She met with that specialist after leaving inpatient care and in 2023 was diagnosed with both Long COVID and ME/CFS. Under proper care, and after plenty of rest, she’s been able to manage her symptoms well enough to return to work and a mostly normal life. “That took me a long time, but I was lucky and found someone who actually helped,” Erin says. “Some people never figure it out.”

The Los Angeles wildfires have killed at least two dozen people and decimated thousands of structures. Yet even in areas that aren’t burning, plumes of smoke remain a serious and ongoing public health threat—especially as the region braces for dangerous winds that could fuel the spread of ash and smoke. “Certainly air pollution problems are nothing new for people who live in Los Angeles and Southern California, but this is a little bit different,” says Dr. Jeremy A. Falk, a pulmonologist and associate professor of medicine at Cedars-Sinai in Los Angeles. “What we’re really worried about is the PM2.5 levels,” or the fine particles in wildfire smoke, which have a diameter of less than 2.5 micrometers. In order for particles to enter your lungs’ air sacs, he says, they have to be just the right size; if they’re too tiny, you’ll breathe them in and out without experiencing any problems, and if they’re too big, they’ll get stuck in your nose or mouth. PM2.5 particles, meanwhile, can settle deep in the lungs, causing a variety of health effects. “If this was all organic smoke—meaning things like trees and vegetation that was burning—we’d have a general sense of what people were inhaling,” Falk says. “But with all the buildings and houses and plastics and chemicals, there’s all sorts of stuff in the air, and the particle sizes that are in that 2.5 range are the ones most likely causing most of the problems.” Read More: What Wildfire Smoke Does to the Human Body Over the short term, elevated PM2.5 exposure can cause a runny nose, coughing and wheezing, eye and throat irritation, and even bronchitis and pneumonia, Falk says. Research suggests high levels can increase the risk of heart attacks, strokes, and arrhythmias, while also raising blood pressure. Certain populations—including young children, the elderly, and people with preexisting heart and lung conditions—are most at risk, though anyone can be affected. It’s too soon to say exactly how the winds forecast to hit Los Angeles will affect the situation. What kind of impact they have depends on their exact patterns. They could “help or hurt,” Falk says. “If most of this gets blown out to uninhabited areas or the ocean, it’s going to do less harm. But it’s certainly, unfortunately, been quite unpredictable.” Here’s how experts advise people in affected areas to take steps to protect themselves. Check your local air-quality report Websites like AirNow.gov offer a real-time status update on the air quality in your neighborhood. Check the Air Quality Index first thing every morning, and again throughout the day, says Dr. John Belperio, interim chief and professor of medicine in the division of pulmonary, critical care, sleep medicine, clinical immunology and allergy at The David Geffen School of Medicine at UCLA. Levels can change rapidly, depending on how fires are progressing and what the weather is like, which is why it’s important to make yourself a repeat visitor. Then adapt your behavior accordingly: If you’re in a green zone (under 50—and parts of LA have registered there at varying times over the past week), it’s generally OK to proceed with your day in normal fashion. Once the air quality level is over 101, however, people with underlying lung disease should take extra precautions and stay indoors as much as possible. “Once the levels start getting above 150”—as was the case in Central LA last week—“everyone can be affected,” he says. “Everybody can have a little bit more inflammation in their lungs.” In those cases, it’s best to rethink any outdoor activities—skip your outdoor bike ride or jog, for example, and hit your home gym instead. One caveat: Falk doesn’t always blindly trust air-quality reports. “With these maps that are readily available on pretty reputable websites, you don’t necessarily know for sure what they're measuring," he says. So if you look outside and it seems really smoky, but you’re allegedly in a green zone, proceed cautiously. “Until the fires really die down, I would recommend continuing masking while you’re outside.” Wear a specific type of face mask Over the last four or five years, we’ve all become self-proclaimed mask experts. But it’s important to understand why the kind of mask you wear during a wildfire might be different from what you wore to protect yourself from COVID-19, Falk notes. “COVID spreads from person to person through respiratory droplets, and while you can't see those droplets—they’re still microscopic—they’re much, much larger than the particles we’re talking about from smoke,” he says. “Because the [virus] particles are bigger, you could get away with using relatively unsophisticated masks. But for this, because the particles are so tiny, they'll pass right through a cloth mask.” He recommends that people in LA wear a tight-fitting N95 or KN95 mask any time they go outside; P-100 respirators also work well and filter out 99.97% of airborne particles. Make some changes inside your home If you live in an area affected by wildfire smoke, keep your windows and doors shut, and seal any obvious cracks, Falk advises. It can also be helpful to keep your air conditioner on (or at least its fan)—though ideally, it won’t be the kind that brings in outdoor air. “You’re much better off recirculating air that's already inside because it's a lot cleaner,” he says. The same goes for your car AC. It’s also smart to change the filters in your air-conditioning system regularly, since they might be getting dirty from wildfire smoke. Air filtration systems can elevate indoor air quality, too. “HEPA filters are great,” Falk says. “The higher the MERV rating, the better, because what that means is it’s basically filtering out smaller particles.” MERV—which stands for “minimum efficiency reporting value”—measures how well an air filter traps particles; the U.S.Environmental Protection Agency (EPA) recommends using MERV 13 filters to make sure you’re removing very small particles, like those in wildfire smoke. Read More: ‘Completely Overwhelming’: L.A. Fire Victims Describe Their Devastating Losses If you have an air purifier, turn it on, Belperio says. These machines vary greatly in quality, and “there’s not the greatest of data—it hasn't been rigorously studied,” he adds. “But if you're in a bad area, I think it can actually be somewhat helpful.” While the EPA doesn’t recommend specific brands of air purifiers, the American Lung Association suggests making sure yours is a mechanical air cleaner that filters out particles using HEPA filters; you should also check to see if it’s certified by the California Air Resources Board. Consider the size of the room where you’ll be using it, too: According to the American Lung Association, use a purifier with a clean air delivery rate (CADR) of up to 200 cubic feet per minute (CFM) for a small room, 200-300 CFM for a medium-sized room, and at least 300 CFM for a large room. Don’t add extra chemicals to the mix Avoid turning on your fireplace, burning a candle, or frying food during the wildfire crisis. All can release chemicals and contribute to air pollution, says Jun Wu, professor of environmental and occupational health at the UC Irvine Joe C. Wen School of Population and Public Health. “It’s already hard for us to clean out the air because of all the fires, and all these particles penetrating into the indoors,” she says. “Think about your lungs and your body as a system that can handle a certain amount of environmental stressors and insulating chemicals.” By generating additional air pollutants, you’ll be putting an even greater burden on your systems, she says, which can take a toll on health. Clean off ash-covered surfaces with a damp mop Sometimes during wildfires, ash—or particulate residue that remains or is deposited on the ground after a fire—might settle in a layer on even indoor surfaces. If there’s ash inside your home, wear an N-95 or P-100 mask while you’re cleaning up. It’s also a good idea to put on goggles, gloves, a long-sleeved shirt, and long pants, according to the South Coast Air Quality Management District (AQMD). That way, your skin won’t come into contact with ash. Read More: What to Say to Someone Who Lost Everything in the California Wildfires If you’re sweeping up ash inside your home, mist it with water first, and then use a damp cloth or mop to clean surfaces, Wu advises. Bag it up before throwing it away, the AQMD suggests. Avoid vacuums unless they have a HEPA filter. “Dry vacuum cleaning can actually rouse these particles,” Wu says. “Normally when you ‘dry’ clean your house, you would get a high amount of fine particle exposure around you, like with dust,” she says. “You’re creating a personal cloud of fine particle matter in your home.” Shower liberally If you live in close proximity to the fires and have to go outside, you could end up with particulate matter on your clothing and skin. “It can be secondary pollution,” Wu says. “It can be carried indoors and spread to others.” That’s why she suggests taking a shower as soon as you get back inside—and washing your dirty clothes. Go to the doctor when you need to If you experience severe coughing, shortness of breath, chest pain, or heart palpitations, you should see a doctor. But it’s also important to pay attention to seemingly less dire symptoms. As everyone in California focuses on the fires, there’s a tendency to ignore other potential health ailments. “We’re in winter,” Belperio says. “There’s a lot of winter viruses. We’re seeing plenty of rhinovirus and influenza, and we’re still seeing some COVID. Don’t just think that this is all fire-related, and that you don't have to do anything.” If you feel like something is off, call your doctor, he advises—they may tell you to put a mask on and come in, or set up a telehealth appointment you can join from home.