The health of Caribbean reefs is under threat from a virulent disease known as stony coral tissue loss disease (SCTLD). Initially reported near Miami in 2014, this disease has since affected coral populations across 18 countries and territories in the region.

Stony coral tissue loss disease devastates coral colonies, leaving behind barren skeletons where vibrant life once thrived.

Transforming Caribbean reefs

A recent study has shed light on the profound shifts occurring within the reef ecosystems due to SCTLD. The disappearance of susceptible coral species is paving the way for more opportunistic organisms – such as macroalgae, cyanobacteria, and fire coral – to dominate.

These “weedy” species, thriving in the absence of their traditional coral competitors, create a landscape vastly different from the once calcified structures of coral reefs.

The ripple effects of these changes are significant. Coral reefs, once bustling with diverse marine life, are transforming into environments dominated by seaweed.

While this new setting benefits certain herbivores, it fails to provide the complex habitat structure needed by other marine species for activities such as hiding, mating, and growing.

Broad ecological changes

“In less than 10 years, a deadly infectious agent called stony coral tissue loss disease (SCTLD) has emerged as a leading threat to Caribbean coral reefs,” wrote the study authors.

“Although its etiology is not fully understood, the discovery of bacterial disease indicators and the success of probiotic treatments suggest that bacteria are involved.” 

“Other evidence suggests that SCTLD is caused by a virus that attacks some corals’ endosymbiotic algae, but not others. SCTLD has reduced coral cover by 30 to 60% in affected regions, pushing a few coral species toward local extinction.”

“Because diseases are most likely to have indirect community effects when they affect connected, unique, or widespread host species, we hypothesized that SCTLD-caused coral loss could trigger broad changes in diverse coral reef ecosystems.”

Long-lasting consequences

Sara Swaminathan, the lead author and a PhD candidate in Environmental Engineering Sciences at the University of Florida, explained the critical implications of these changes. “While some fast-growing organisms might initially thrive, the broader ecological balance is tipped, potentially leading to long-lasting repercussions,” she noted.

Further studies involving data from various U.S. territories, including Florida, Puerto Rico, and the U.S. Virgin Islands, have highlighted additional consequences.

For instance, the disease impacts crustose coralline algae, vital for reef building, thereby inhibiting the structural integrity and resilience of the reefs themselves.

Fish and their changing habitats

The research team also discovered that the impact of the coral disease on fish populations is nuanced. Some fish species find new advantages in the altered environments, while others suffer due to the loss of their habitats.

The roughness of the coral, or rugosity, now plays a more significant role in determining the suitability of these habitats for different fish species, regardless of whether the coral is alive.

Kevin Lafferty, a senior scientist with the U.S. Geological Survey, highlighted the complexity of SCTLD’s impact. “Some infectious diseases reshape entire ecosystems, and SCTLD is a prime example, creating a mix of winners and losers among marine species,” he remarked.

Collaborative efforts to preserve Caribbean reefs

The international community, including marine biologists and conservationists, has rallied to address this crisis. Efforts to understand the mechanisms behind the disease and develop potential treatments are ongoing. Promising approaches like the application of probiotics to affected corals show potential in mitigating the disease’s progression.

Andrew Altieri, an assistant professor and associate director at the Center for Coastal Solutions, emphasized the broader implications of coral loss. “Coral reefs are not just biodiversity hotspots; they are crucial for the survival of numerous marine species and for the protection of coastal economies relying on fishing and tourism,” he stated.

The collective efforts of researchers and conservationists are crucial in preserving these vital ecosystems.

As the battle against stony coral tissue loss disease continues, the commitment to understanding and combating this disease remains paramount, not only for the health of the coral reefs but for the countless human and marine lives that depend on them.

The study is published in the journal Science Advances.

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Patients with schizophrenia are more likely to be admitted for hospital stays—and experience lengthier durations of stay and therefore, costlier care—for conditions including sepsis, COPD exacerbation, and pneumonia.

According to a data analysis presented at the American Psychiatric Association (APA) 2024 Annual Meeting in New York, NY, this week, investigators reported findings highlighting a significantly disparate hospitalization experience for patients with schizophrenia when presenting with non-psychiatric conditions for emergent care. The data may allude to potential pursuits in qualitative research that can better identify the drivers of elongated and exacerbated hospital stays experienced by patients with schizophrenia.

The research team conducted a retrospective analysis to identify the most common reasons for hospital admissions among patients with schizophrenia. As they noted, such patients have a well-evidenced shorter life span than the general population—up to 20 years on average, according to research. But their shorter life spans are often due to illnesses beyond their psychiatric condition.

“Understanding the most common causes of hospitalization in patients with mental illness could provide clues on how to improve preventive health monitor adverse effects of medications and provide better in-hospital care,” the team wrote.

Investigators compiled state-level inpatient hospitalization data for adults aged ≥18 years old between 2016 – 2019 from the National Inpatient Sample (NIS) database. They identified the 10 most common primary diagnoses for hospital admission of patients with and without schizophrenia based on the data, before conducting a multivariate logistic regression to assess the impact of schizophrenia on the odds of being admitted with each of the top 10 primary diagnoses.

They then analyzed proportions for each diagnosis, as well as odds ratios (ORs) for admission while excluding for schizophrenia-based admissions to fully interpret the drivers of non-psychiatric hospital admissions among patients with schizophrenia. Lastly, they compared the characteristics, lengths of stay, and in-hospital mortality of patients with each diagnosis across the schizophrenia and control cohorts.

Their final analysis showed schizophrenia-related diagnoses accounted for only one-third (35%) of hospital admissions among such patients, compared to 65% of admissions being due to other causes. Among the primary diagnoses to be 1 of the 10 most prevalent in both hospitalized patients with and without schizophrenia included:

• Sepsis
• COPD exacerbation
• Acute renal failure
• Pneumonia
• Urinary tract infection (UTI)
• Hypertensive heart failure

The other most prevalent primary diagnoses in patients with schizophrenia included hyponatremia, aspiration pneumonia, and acute hypoxic respiratory failure. Patients without schizophrenia were more likely to be admitted to the hospital due to non-ST-elevation myocardial infarction or knee osteoarthritis than patients with schizophrenia.

Investigators found that patients with schizophrenia were significantly more likely to be admitted for most of the observed medical illnesses, except for heart failure and acute renal failure. Though patients with schizophrenia were likely to die from sepsis, acute hypoxic respiratory failure and aspiration pneumonia than the control cohort, they were also shown to have significantly longer lengths of hospital stay for all diagnoses, as well as greater costs of care for most diagnoses.

The data elucidated a tendency for patients with schizophrenia to experience a more difficult hospitalization—despite their non-psychiatric diagnoses trending similarly to hospitalized patients without schizophrenia.

“Our results can guide future directions for targeting disparities in healthcare for patients with schizophrenia and illustrate possible areas of research,” investigators concluded.

References

1. ^{Venkataramanan A, et al. Most common causes of nonpsychiatric hospitalizations in patients with schizophrenia in the United States. Paper presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4-8, 2024.}
2. ^{Peritogiannis V, Ninou A, Samakouri M. Mortality in Schizophrenia-Spectrum Disorders: Recent Advances in Understanding and Management. Healthcare (Basel). 2022;10(12):2366. Published 2022 Nov 25. doi:10.3390/healthcare10122366}

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