Sounds of sickness: can people identify infectious disease using sounds of coughs and sneezes?

Think positive! Resolving human motion ambiguity in the presence of disease threat

Recently, approach-avoidance tendencies and visual perception biases have been increasingly studied using bistable point-light walkers (PLWs). Prior studies have found a facing-the-viewer bias when one is primed with general threat stimuli (e.g. angry faces), explained by the "error management theory", as failing to detect a threat as approaching is riskier than the opposite. Importantly, no study has explored how disease threat - linked to the behavioural immune system - might affect this bias. This study aimed to explore whether disease-signalling cues can alter how we perceive the motion direction of ambiguous PLWs. Throughout 3 experiments, participants indicated the motion direction of a bistable PLW previously primed with a control or disease-signalling stimuli - that is, face with a surgical mask (Experiment 1), sickness sound (Experiment 2), or face with a disease cue (Experiment 3). Results showed that sickness cues do not significantly modulate the perception of approach-avoidance behaviours. However, a pattern emerged in Experiments 2 and 3, suggesting that sickness stimuli led to more facing away percepts. Unlike other types of threat, this implies that disease-related threat stimuli might trigger a distinct perceptual bias, indicating a preference to avoid a possible infection source. Nonetheless, this finding warrants future investigations.

Acoustic Analysis of Voluntary Coughs, Throat Clearings, and Induced Reflexive Coughs in a Healthy Population

Cough efficacy is considered a reliable predictor of the aspiration risk in head and neck cancer patients with radiation-associated dysphagia. Currently, coughing is assessed perceptually or aerodynamically. The goal of our research is to develop methods of acoustic cough analysis. In this study, we examined in a healthy population the acoustical differences between three protective maneuvers: voluntary cough, voluntary throat clearing, and induced reflexive cough. Forty healthy participants were included in this study. Voluntary cough, voluntary throat clearing, and reflexive cough samples were recorded and analyzed acoustically. Temporal acoustic features were the following: the slope and curvature of the amplitude contour, as well as the average, slope, and curvature of the sample entropy and kurtosis contours of the recorded signal. Spectral features were the relative energy in the frequency bands (0-400 Hz, 400-800 Hz, 800-1600 Hz, 1600 Hz-3200 Hz, > 3200 Hz) as well as the weighted spectral energy. Results showed that, compared to a voluntary cough, a throat clearing starts with a weaker onset pulse and involves oscillations from the onset to the offset (concave curvature of the amplitude contour, p < 0.05), lower average (p < 0.05), and slope (p < 0.05) as well as lower convex curvature (p < 0.05) of the kurtosis contour. An induced reflexive cough starts with a higher and briefer onset burst and includes higher frication noise (larger convexity of the curvature of the amplitude and kurtosis contours (p < 0.05)) compared to a voluntary cough. The conclusion is that voluntary coughs are acoustically significantly different from voluntary throat clearings and induced reflexive coughs.

Immunoactivation Affects Perceived Body Odor and Facial but Not Vocal Attractiveness

Several previous studies have shown that in mammals, the health status of conspecifics can be assessed based on perceptual cues. Olfactory, visual, or acoustic cues may lead to avoidant behavior, thus reducing the risk of contagion by close contact with infected individuals. We tested whether immune system activation after immunization leads to perceptible changes in body odor and facial and vocal attractiveness in humans. We have experimentally activated the immune system of male participants using vaccination against hepatitis A/B and meningococcus. Their body odor, facial photographs, and vocal recordings were collected before and 14 days after vaccination. Subsequently, the body odor samples, facial photographs, and vocal recordings were assessed by female raters for their attractiveness and healthiness. We have also measured skin coloration (from facial photographs and in vivo using a spectrophotometer), vocal parameters, and C-reactive protein (CRP) levels as a marker of inflammation. We found an increase in perceived body odor attractiveness, a decrease in facial attractiveness and healthiness, and no change in vocal attractiveness 14 days after vaccination compared to the prevaccination condition. Moreover, there was no change in facial coloration or vocal parameters between the prevaccination and postvaccination conditions. Prevaccination CRP levels were negatively associated with body odor and facial attractiveness and positively associated with body odor intensity. Overall, our results suggest that perceived body odor as well as facial but not vocal attractiveness may provide cues to activation of the immune response and that each modality may carry specific information about the individual's condition.

Disgust in animals and the application of disease avoidance to wildlife management and conservation

Disgust is an adaptive system hypothesized to have evolved to reduce the risk of becoming sick. It is associated with behavioural, cognitive and physiological responses tuned to allow animals to avoid and/or get rid of parasites, pathogens and toxins. Little is known about the mechanisms and outcomes of disease avoidance in wild animals. Furthermore, given the escalation of negative human-wildlife interactions, the translation of such knowledge into the design of evolutionarily relevant conservation and wildlife management strategies is becoming urgent. Contemporary methods in animal ecology and related fields, using direct (sensory cues) or indirect (remote sensing technologies and machine learning) means, provide a flexible toolbox for testing and applying disgust at individual and collective levels. In this review/perspective paper, we provide an empirical framework for testing the adaptive function of disgust and its associated disease avoidance behaviours across species, from the least to the most social, in different habitats. We predict various trade-offs to be at play depending on the social system and ecology of the species. We propose five contexts in which disgust-related avoidance behaviours could be applied, including endangered species rehabilitation, invasive species, crop-raiding, urban pests and animal tourism. We highlight some of the perspectives and current challenges of testing disgust in the wild. In particular, we recommend future studies to consider together disease, predation and competition risks. We discuss the ethics associated with disgust experiments in the above contexts. Finally, we promote the creation of a database gathering disease avoidance evidence in animals and its applications.

Behavioral and physiological sensitivity to natural sick faces

The capacity to rapidly detect and avoid sick people may be adaptive. Given that faces are reliably available, as well as rapidly detected and processed, they may provide health information that influences social interaction. Prior studies used faces that were manipulated to appear sick (e.g., editing photos, inducing inflammatory response); however, responses to naturally sick faces remain largely unexplored. We tested whether adults detected subtle cues of genuine, acute, potentially contagious illness in face photos compared to the same individuals when healthy. We tracked illness symptoms and severity with the Sickness Questionnaire and Common Cold Questionnaire. We also checked that sick and healthy photos were matched on low-level features. We found that participants (N = 109) rated sick faces, compared to healthy faces, as sicker, more dangerous, and eliciting more unpleasant feelings. Participants (N = 90) rated sick faces as more likely to be avoided, more tired, and more negative in expression than healthy faces. In a passive-viewing eye-tracking task, participants (N = 50) looked longer at healthy than sick faces, especially the eye region, suggesting people may be more drawn to healthy conspecifics. When making approach-avoidance decisions, participants (N = 112) had greater pupil dilation to sick than healthy faces, and more pupil dilation was associated with greater avoidance, suggesting elevated arousal to threat. Across all experiments, participants' behaviors correlated with the degree of sickness, as reported by the face donors, suggesting a nuanced, fine-tuned sensitivity. Together, these findings suggest that humans may detect subtle threats of contagion from sick faces, which may facilitate illness avoidance. By better understanding how humans naturally avoid illness in conspecifics, we may identify what information is used and ultimately improve public health.

Assessment of cough in head and neck cancer patients at risk for dysphagia-An overview

BACKGROUND

This literature review explores the terminology, the neurophysiology, and the assessment of cough in general, in the framework of dysphagia and regarding head and neck cancer patients at risk for dysphagia. In the dysphagic population, cough is currently assessed perceptually during a clinical swallowing evaluation or aerodynamically.

RECENT FINDINGS

Recent findings have shown intra and inter-rater disagreements regarding perceptual scoring of cough. Also, aerodynamic measurements are impractical in a routine bedside assessment. Coughing, however, is considered to be a clinically relevant sign of aspiration and dysphagia in head and cancer patients treated with concurrent chemoradiotherapy.

CONCLUSION

This article surveys the literature regarding the established cough assessment and stresses the need to implement innovative methods for assessing cough in head and neck cancer patients treated with concurrent chemoradiotherapy at risk for dysphagia.

What Role Does Pathogen-Avoidance Psychology Play in Pandemics?

A substantial body of research has illuminated psychological adaptations motivating pathogen avoidance, mechanisms collectively known as the behavioral immune system. Can knowledge about these mechanisms inform how people respond to widespread disease outbreaks, such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] pandemic? We review evidence suggesting that the evolutionary history of the behavioral immune system, and the cues that activate it, are distinct in many ways from modern human experiences with pandemics. Moreover, the behaviors engaged by this system may have limited utility for combating pandemic diseases like COVID-19. A better understanding of the points of distinction and points of overlap between our evolved pathogen-avoidance psychology and responses to pandemics may help us realize a more precise and intervention-ready science.

Behavioral Immunity and Social Distancing in the Wild: The Same as in Humans?

The COVID-19 pandemic imposed new norms on human interactions, perhaps best reflected in the widespread application of social distancing. But social distancing is not a human invention and has evolved independently in species as dissimilar as apes and lobsters. Epidemics are common in the wild, where their spread is enhanced by animal movement and sociality while curtailed by population fragmentation, host behavior, and the immune systems of hosts. In the present article, we explore the phenomenon of behavioral immunity in wild animals as compared with humans and its relevance to the control of disease in nature. We start by explaining the evolutionary benefits and risks of sociality, look at how pathogens have shaped animal evolution, and provide examples of pandemics in wild animal populations. Then we review the known occurrences of social distancing in wild animals, the cues used to enforce it, and its efficacy in controlling the spread of diseases in nature.

Emerging infectious disease and the challenges of social distancing in human and non-human animals

The 'social distancing' that occurred in response to the COVID-19 pandemic in humans provides a powerful illustration of the intimate relationship between infectious disease and social behaviour in animals. Indeed, directly transmitted pathogens have long been considered a major cost of group living in humans and other social animals, as well as a driver of the evolution of group size and social behaviour. As the risk and frequency of emerging infectious diseases rise, the ability of social taxa to respond appropriately to changing infectious disease pressures could mean the difference between persistence and extinction. Here, we examine changes in the social behaviour of humans and wildlife in response to infectious diseases and compare these responses to theoretical expectations. We consider constraints on altering social behaviour in the face of emerging diseases, including the lack of behavioural plasticity, environmental limitations and conflicting pressures from the many benefits of group living. We also explore the ways that social animals can minimize the costs of disease-induced changes to sociality and the unique advantages that humans may have in maintaining the benefits of sociality despite social distancing.

What people believe about detecting infectious disease using the senses

Do you believe you can tell if people are sick with infectious diseases by looking at, listening to, or smelling them? Research on pathogen detection and avoidance suggests that perceivers respond with caution both to true signs of infection and to cues only heuristically associated with infection threat. But what do perceivers actually believe about the effectiveness and use of specific sensory modalities for infection detection? In several studies, U.S. participants reported perceptions of effectiveness and likelihood of using each of the major senses to identify infection threat in two types of targets: people and food. Results revealed prioritization of sight and sound with person targets and prioritization of sight and smell with food targets. These patterns appear consistent with the use of "safe senses" (avoidance of cues involving high perceived transmission risk). Beliefs about sensory use also varied depending on the specific feature being examined, with different patterns of sensory beliefs associated with evaluation of pathogenic danger than with evaluation of desirability and fit with normative standards. We discuss these lay beliefs in the context of recent calls for descriptive research in psychology as well as their implications for current and future work on the behavioral immune system.