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Sean Clouston

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By Daniel Dunaief

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The number of people battling significant symptoms from the flu and respiratory syncytial virus has been coming down since its peak in January, as these infections have run their course.

“This year, we experienced the most severe flu and RSV waves in decades, and our COVID wave wasn’t small either,” said Sean Clouston, associate professor of Public Health at Stony Brook University.

The number of these illnesses was high as people no longer wore masks in places like schools and after people experienced lower-than-usual illnesses in the months before the mask mandate was lifted, creating fertile ground for viruses to spread.

“The most likely reason that the current flu and RSV seasons have improved is that we have had such a bad season earlier on that we have hit a natural ceiling on the ability for these diseases to successfully infect more people,” Clouston said in an email.

As for COVID-19, the numbers of people who have developed significant illnesses has continued to decline as well, through a combination of the natural immunity people have after their bodies successfully fought off the infection and from the protection offered by the vaccine and boosters.

Doctors added that the vaccine and natural immunity hasn’t prevented people from getting infected, but they have helped people avoid severe and potentially life-threatening symptoms.

“All these people who run around saying, ‘My vaccine isn’t working because I got reinfected,’ are missing the point,” said Dr. Bettina Fries, chief of the Division of Infectious Diseases at Stony Brook Medicine. “It is working. It doesn’t protect you from infection, but [it does prevent] a bad outcome.”

Indeed, during the most recent COVID surge during the winter, Fries said the hospital continued to care for patients, most of whom recovered. 

Vaccine timing

Amid discussions from the Centers for Disease Control and Prevention and health organizations throughout the state and country about the timing of future booster shots, local health care providers indicated the increasing likelihood of an annual COVID booster.

Fries said we will get to an annual vaccination for COVID, adding, “It’s the same as we see with the flu.”

In general, people aren’t rushing off to get an updated COVID booster.

“To maximize the protective value of the vaccine while minimizing the number of vaccines you use, people should likely get the vaccine two weeks before they anticipate heavy exposure,” Clouston said.

For most people, that would mean getting the shot in early November to prepare for larger indoor gatherings, like Thanksgiving and the December holidays.

In a recent article in the journal Lancet, researchers conducted an extensive analysis of COVID reinfection rates.

The study dealt only with those people who had not had any vaccinations and addressed the effectiveness of natural immunity from preventing infections and from the worst symptoms of the disease.

Prior infections in general didn’t prevent people from getting reinfected, but it does “protect you from getting a really bad disease and dying,” Fries said.


Even with the number of people contracting COVID declining, the overall population of people battling symptoms of long COVID, which can still include anything from loss of smell and taste to chronic fatigue, continues to increase.

“There’s a plethora of symptoms of long COVID,” Fries said. “We’ll have to figure out how to classify this and hopefully come up with better therapy. Right now, we can only symptomatically treat these patients.”

Dr. Sritha Rajupet, director of the Stony Brook Medicine Post-COVID Clinic, explained in an email that some patients who have lost their sense of smell or have a distorted sense of taste have tried a process called a stellate ganglion block “after several case reports and early research have shown that it could be helpful.”

In such a procedure, doctors inject a local anesthetic on either side of the voice box into the neck. Rajupet said that “additional research and clinical trials still have to be performed.”

Newborns and COVID

As for children infected with COVID soon after birth, doctors suggested that the impact has been manageable.

“The great majority of young children who contract COVID do quite well and recover fully,” Dr. Susan Walker, pediatrician with Stony Brook Children’s Services, explained in an email. “The impact on their development from having actually experienced COVID illness is minimal.”

Children hospitalized with more significant illness from COVID might experience temporary developmental regression which is common in children hospitalized for any reason. The developmental impact seems more tied to social isolation.

“Children born during the pandemic spent their first years of life rarely seeing adults or children other than those in their immediate family,” Walker said. “The result is that many of these kids became excessively stranger anxious and timid around others.”

The lost social opportunities, the pediatrician said, resulted in delays in the personal/social domain of development. She added, “The good news is that kids are resilient and, in time, with appropriate social stimulation, [these children] should be able to regroup and catch up developmentally.”

Sean Clouston. Photo by Rachel Kidman

By Daniel Dunaief

The same wind that powers sailboats, makes kites dart through the air, and causes flags to flutter can make being outdoors in a group safer, particularly during the pandemic.

While public health officials have suggested that being outdoors with others amid the pandemic is safer than remaining inside, the strength of the wind can affect the level of protection provided by wide open spaces.

That’s the conclusion Sean Clouston, Associate Professor in the Program in Public Health and the Department of Family, Population and Preventive Medicine at the Renaissance School of Medicine at Stony Brook University, reached after studying public health data from 96,000 cases of COVID in Suffolk County from March 16, 2020 to December 31, 2020.

By combining public health data with the daily reports from the National Oceanic and Atmospheric Administration, Clouston found that days in which the temperature was between 60 and 84 degrees Fahrenheit and in which the wind was about 5 miles per hour or less had higher COVID-19 transmission than those days in which the wind speed was faster.

This kind of study, which was recently published in the journal BMC Infectious Disease, might affect the guidance policy makers provide to reduce the risk of COVID transmission during outdoor gatherings.

“If you’re imaging yourself as a policy maker and you want to contain COVID, what do you do?” Clouston asked rhetorically. Vaccines and masks are established tools. Ensuring airflow is higher might also be important, he suggested.

Indeed, amid the early days of the pandemic in 2020, public officials closed parks in Suffolk County for a while and eventually reopened them.

An alternative could be to provide access to parks where wind speed is also protective, or to reduce the use of parks where social distancing is difficult and where wind speed is lower.

At the same time, residents might want to protect themselves by putting out fans in their backyard or some other airflow devices to keep the flow of air moving during a social gathering, reducing the chance of transmitting the virus. People might want to avoid using tents that reduce the flow of air around them.

Additionally, people could eat out at restaurants where the airflow is stronger. 

Diners can search for places where the air “moves around, so the outdoor experience is as protective as possible,” Clouston said. He recognized that the data had some variability between when people who went outside might have contracted COVID. The air flow could increase and then decrease and the average length of time from exposure to symptoms and testing could differ between people.

“Any time we deal with humans, this is the problem,” Clouston said. Researchers can’t control for everything. Instead, they have to assume people make decisions in a consistent, but variable, way.

The larger data set, with close to 100,000 cases, enabled Clouston and his colleagues to average out the effects of the time when people reported their positive COVID tests.

For numerous cases, people had a good idea where and how they contracted COVID. Even when they were at outdoor events, such as a barbecue, some people had indoor parties where they ate together.

In addition, merely being outdoors didn’t reduce the risk if people were standing in the equivalent of stale air, where wind couldn’t reach them and help carry viral particles away from others who attended these events.

Being outside if the air isn’t moving is similar to being indoors in a space with a very large ceiling and a wide space between walls, he explained. It is safer than a small room, but it is not inherently safe on its own.

As for air circulation indoors, Clouston said people have suggested that moving air in buildings could reduce the spread of the virus.

Testing the effects of having HEPA filters or air filtration systems run continuously in hospitals  compared to areas that don’t have such units could reveal the benefit of having these air flow systems. Some studies have been done on this, although more work is ongoing, he said. 

Clouston suggested that other environmental conditions could also impact the transmissibility of the virus. The heat index, for example, might explain why wind speed might be important.

The heat index “might diminish the effect or make it stronger,” Clouston said. “It can push people indoors.”

Clouston worked on this study with Stony Brook colleagues in the Department of Family, Population and Preventive Medicine Assistant Professor Olga Morozova and Professor Jaymie Meliker. The team has worked with the Suffolk County Department of Health since 2020 on different aspects of COVID modeling.

Clouston was surprised that the research revealed a threshold model wind speed. He was also surprised to see that the speed was so low. “You only need a little airflow,” he explained.

The Stony Brook scientist looked at where the positive cases were located by zip code. The summer distribution and the spatial distribution was somewhat unclear, he said.

The spread of COVID was distributed by population size and density. Population size and density are likely more important than alterations in microclimate in the summer.

The analysis is important for places when and where outdoor exposures are most common, he explained.

“This may be true in the summer on Long Island or in the winter in southern states like Louisiana when outdoor activities are more comfortable,” he wrote in an email.

Clouston has several ongoing projects. He has papers discussing the role of social inequalities and COVID, a paper looking at clinical risk factors for COVID at Stony Brook Hospital, and one describing the initial wave of COVID in World Trade Center responders.

He would like to look at the effect of outdoor protests during 2020 on the spread of COVID, which would require data on attendance at those events and at the ones in New York City.

Sean Clouston

By Daniel Dunaief

Every year, the country pauses on 9/11, remembering the victims of the terrorist attacks and reflecting on the safety and security of the country. At the same time, a Stony Brook University study continues not only to remember the first responders but also to understand the physical and mental consequences of the work police, firefighters and other first responders performed in the immediate aftermath of the attacks.

Benjamin Luft

Recently, Sean Clouston, an associate professor in the Department of Family, Population & Preventive Medicine at SBU Renaissance School of Medicine, and Ben Luft, the director of the SBU WTC Health and Wellness Program since 2003, published research in which they demonstrated a link between a protein commonly connected with Alzheimer’s disease to post-traumatic stress disorder, or PTSD, in first responders.

In a small preliminary study, the researchers found a difference in the level of the protein between first responders who are battling chronic PTSD and those who aren’t battling the condition. The Stony Brook scientists published their work in the journal Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

The researchers cautioned that the presence of the markers doesn’t necessarily indicate anything about present or future changes in cognitive function.“We don’t know the specificity of the markers,” Luft explained in an email.

Amyloid is generally considered the earliest marker of Alzheimer’s disease, which includes cognitive decline. Some people, however, have significant amounts of amyloid and don’t develop problems with their thinking. Neurodegenerative diseases without amyloid rarely have severe symptoms, which don’t appear to worsen with time.

“This paper doesn’t look at cognitive symptoms,” Clouston said. “We do have papers looking at cognitive impairment and other memory-based differences. It wasn’t a part of this paper.”

The newest research is part of an ongoing program in which the university follows 11,000 responders who came to the World Trade Center. The study for this paper involved a smaller subset of this population. This type of research can and does have application to other studies of people who have traumatic experiences, the scientists suggest.

Most traumatic experiences are unique to each person, as people who suffer physical and emotional trauma in combat often confront the aftereffects of head injuries. Among the first responder population who survived the attacks on 9/11, most of them “faired pretty well physically,” Clouston said. 

“We didn’t have a lot of head injuries. Understanding PTSD in this crowd is really useful for the literature as a whole because it allows us to focus on the long-term psychiatric fallout of an event without worrying about exposures that are different.”

The scientists had at least some idea of the timing and duration of exposures. This research suggests that it might be helpful to think about the kinds of problems that cognitive impairment can cause, which might involve managing other health-related problems.

Luft added that the population they are studying shows the benefit of immediate care. “One thing for sure is that the care of the first responders has to occur very quickly,” he said. “Now that we know the history, the greatest chance you have in mitigating the effect of this type of trauma is to deal with the problem from the get-go.” 

Sean Clouston with his daughter Quinn at Benner’s Farm in Setaukt. with his daughter Quinn. Photo by Rachel Kidman

First responders have benefited from psychotherapy as well as from various pharmacological treatments. Luft suggested that they might even benefit from having therapists available in the field, where they can receive near instantaneous psychological support.

In addition to the psychological trauma, first responders have had physical effects from their work in the aftermath of the attacks, such as respiratory and gastrointestinal problems, as well as autoimmunity issues.

People have these problems because “of the pro-inflammatory effect of PTSD itself,” said Luft. The researchers believe trauma can affect the immune system and the brain.

According to Clouston, the next step with this work is to replicate it with a larger scale. The experiment was “fairly expensive and untried in this population and novel in general, so we started small,” he explained in an email. The scientists would like to “get a larger range of responders and to examine issues surrounding symptomatology and other possible explanations.”

Clouston has been at Stony Brook for six years. Prior to his arrival on Long Island, he worked on a collaborative project that was shared between University College London and the University of Victoria. 

An expert in aging, he felt like his arrival came at just the right time for the WTC study, as many of the first responders were turning 50. After giving talks about the cognitive and physical effects of aging, he met Luft and the two decided to collaborate within six months of his arrival.

Clouston is focused on whether PTSD caused by the terrorist attacks themselves have caused early brain aging. A self-proclaimed genetics neophyte, he appreciates the opportunity to work with other researchers who have considerably more experience in searching for molecular signatures of trauma.

Clouston said his family has suffered through the trauma of cognitive decline during the aging process. His family’s struggles “definitely bring [the research] home,” reminding him of the “terror that many family members feel when they start noticing problems in their siblings, parents, spouses, etc.”

As for his work on the recent study, he said he is excited about the next steps. “Little is known about the subtypes of amyloid,” he suggested and there’s a “lot more to explore about the role [of this specific type] in the population. I do think it could be really informative about the types of symptoms.”