{"id":"https://openalex.org/W7206202062","doi":"https://doi.org/10.64898/2026.08.31.26356614","title":"Prevalence and Functional Outcomes of Post-Exertional Malaise among Adults with prior COVID-19: Results from a Representative Survey of New York City Residents","display_name":"Prevalence and Functional Outcomes of Post-Exertional Malaise among Adults with prior COVID-19: Results from a Representative Survey of New York City Residents","publication_year":2026,"publication_date":"2026-09-02","ids":{"openalex":"https://openalex.org/W7206202062","doi":"https://doi.org/10.64898/2026.08.31.26356614"},"language":"en","primary_location":{"id":"doi:10.64898/2026.08.31.26356614","doi":"https://doi.org/10.64898/2026.08.31.26356614","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.31.26356614","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/02/2026.08.31.26356614.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/02/2026.08.31.26356614.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5091207420","display_name":"Samuel E. Packard","orcid":"https://orcid.org/0000-0001-8607-792X","observed_orcids":["https://orcid.org/0000-0001-8607-792X"]},"institutions":[{"id":"https://openalex.org/I1334095494","display_name":"New York City Department of Health and Mental Hygiene","ror":"https://ror.org/01gst4g14","country_code":"US","type":"government","lineage":["https://openalex.org/I1334095494"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Samuel E. Packard","raw_affiliation_strings":["New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101"],"raw_orcid":"https://orcid.org/0000-0001-8607-792X","affiliations":[{"raw_affiliation_string":"New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101","institution_ids":["https://openalex.org/I1334095494"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5078792027","display_name":"Therese Russo","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210164579","display_name":"Action Network","ror":"https://ror.org/058kybv57","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210164579"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Therese Russo","raw_affiliation_strings":["Myalgic Encephalomyelitis Action Network"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Myalgic Encephalomyelitis Action Network","institution_ids":["https://openalex.org/I4210164579"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5082153527","display_name":"Jannae C. Parrott","orcid":"https://orcid.org/0000-0002-4116-4701","observed_orcids":["https://orcid.org/0000-0002-4116-4701"]},"institutions":[{"id":"https://openalex.org/I1334095494","display_name":"New York City Department of Health and Mental Hygiene","ror":"https://ror.org/01gst4g14","country_code":"US","type":"government","lineage":["https://openalex.org/I1334095494"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jannae Parrott","raw_affiliation_strings":["New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101","institution_ids":["https://openalex.org/I1334095494"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5066698879","display_name":"Julia S. Sisti","orcid":"https://orcid.org/0000-0003-2646-9758","observed_orcids":["https://orcid.org/0000-0003-2646-9758"]},"institutions":[{"id":"https://openalex.org/I1334095494","display_name":"New York City Department of Health and Mental Hygiene","ror":"https://ror.org/01gst4g14","country_code":"US","type":"government","lineage":["https://openalex.org/I1334095494"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Julia Sisti","raw_affiliation_strings":["New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101","institution_ids":["https://openalex.org/I1334095494"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5081310156","display_name":"Amanda Lans","orcid":"https://orcid.org/0000-0002-4959-6517","observed_orcids":["https://orcid.org/0000-0002-4959-6517"]},"institutions":[{"id":"https://openalex.org/I1334095494","display_name":"New York City Department of Health and Mental Hygiene","ror":"https://ror.org/01gst4g14","country_code":"US","type":"government","lineage":["https://openalex.org/I1334095494"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Amanda Lans","raw_affiliation_strings":["New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"New York City Department of Health and Mental Hygiene, 42-09 28th St. Long Island City, NY 11101","institution_ids":["https://openalex.org/I1334095494"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5091207420"],"corresponding_institution_ids":["https://openalex.org/I1334095494"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11368","display_name":"Long-Term Effects of COVID-19","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11368","display_name":"Long-Term Effects of COVID-19","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11282","display_name":"Fibromyalgia and Chronic Fatigue Syndrome Research","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2738","display_name":"Psychiatry and Mental health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10168","display_name":"COVID-19 and Mental Health","score":0.0,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/post-exertional-malaise","display_name":"post-exertional malaise","score":0.9909999966621399},{"id":"https://openalex.org/keywords/covid-19","display_name":"COVID-19 pandemic","score":0.7689999938011169},{"id":"https://openalex.org/keywords/long-covid","display_name":"long COVID","score":0.8420000076293945},{"id":"https://openalex.org/keywords/chronic-fatigue-syndrome","display_name":"chronic fatigue syndrome","score":0.9629999995231628},{"id":"https://openalex.org/keywords/prevalence","display_name":"prevalence","score":0.9330000281333923},{"id":"https://openalex.org/keywords/depression","display_name":"depression","score":0.7409999966621399},{"id":"https://openalex.org/keywords/anxiety","display_name":"anxiety","score":1.0},{"id":"https://openalex.org/keywords/disability","display_name":"disability","score":0.9789999723434448},{"id":"https://openalex.org/keywords/mental-health","display_name":"mental health","score":0.6830000281333923},{"id":"https://openalex.org/keywords/symptom-duration","display_name":"symptom duration","score":0.6230000257492065},{"id":"https://openalex.org/keywords/health-disparities","display_name":"health disparities","score":0.5230000019073486},{"id":"https://openalex.org/keywords/racial-and-ethnic-disparities","display_name":"racial and ethnic disparities","score":0.6759999990463257},{"id":"https://openalex.org/keywords/new-york-city","display_name":"New York City","score":0.6610000133514404}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7411999702453613},{"id":"https://openalex.org/C2779277585","wikidata":"https://www.wikidata.org/wiki/Q2673323","display_name":"Malaise","level":2,"score":0.7171000242233276},{"id":"https://openalex.org/C134362201","wikidata":"https://www.wikidata.org/wiki/Q317309","display_name":"Mental health","level":2,"score":0.6499999761581421},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.5453000068664551},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.4586000144481659},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.4097999930381775},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.3921000063419342},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.3774999976158142},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.3560999929904938},{"id":"https://openalex.org/C186079640","wikidata":"https://www.wikidata.org/wiki/Q719602","display_name":"Prevalence","level":3,"score":0.351500004529953},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.3513000011444092},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.3474999964237213},{"id":"https://openalex.org/C2779159551","wikidata":"https://www.wikidata.org/wiki/Q1414874","display_name":"Comorbidity","level":2,"score":0.3393999934196472},{"id":"https://openalex.org/C49898467","wikidata":"https://www.wikidata.org/wiki/Q1517706","display_name":"Stratified sampling","level":2,"score":0.3375000059604645},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.31200000643730164},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.30820000171661377},{"id":"https://openalex.org/C2987552334","wikidata":"https://www.wikidata.org/wiki/Q383126","display_name":"Chronic disease","level":2,"score":0.28949999809265137},{"id":"https://openalex.org/C187155963","wikidata":"https://www.wikidata.org/wiki/Q629029","display_name":"Occupational safety and health","level":2,"score":0.2700999975204468},{"id":"https://openalex.org/C197934379","wikidata":"https://www.wikidata.org/wiki/Q2047938","display_name":"Adverse effect","level":2,"score":0.2648000121116638},{"id":"https://openalex.org/C125920245","wikidata":"https://www.wikidata.org/wiki/Q6971726","display_name":"National Comorbidity Survey","level":3,"score":0.25119999051094055}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.08.31.26356614","doi":"https://doi.org/10.64898/2026.08.31.26356614","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.31.26356614","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/02/2026.08.31.26356614.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.08.31.26356614","doi":"https://doi.org/10.64898/2026.08.31.26356614","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.08.31.26356614","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/02/2026.08.31.26356614.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"},{"display_name":"Reduced inequalities","score":0.4074000120162964,"id":"https://metadata.un.org/sdg/10"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[{"id":"https://openalex.org/G7851265934","display_name":"NEW YORK CITY DEPARTMENT OF HEALTH & MENTAL HYGIENE (NYC DOHMH)STRENGTHENING U.S. PUBLIC HEALTH INFRASTRUCTURE, WORKFORCE, AND DATA SYSTEMSCDC-RFA-OE22-2203 - NEW YORK CITY DEPARTMENT OF HEALTH & MENTAL HYGIENE STRENGTHENING U.S. PUBLIC HEALTH INFRASTRUCTURE, WORKFORCE, AND DATA SYSTEMS CDC-RFA-OE22-2203 PROJECT ABSTRACT SUMMARY  NEW YORK CITY FACED SIGNIFICANT PUBLIC HEALTH AND HEALTHCARE SYSTEM IMPACTS FROM THE COVID-19 PANDEMIC, WHICH LAID BARE LONG-STANDING WEAKNESSES AND CREATED NEW CHALLENGES TO THE PUBLIC HEALTH INFRASTRUCTURE. THE PANDEMIC AND ITS MANY IMPACTS REVEALED DISPARITIES AND GAPS IN THE CITY\u2019S PUBLIC HEALTH SYSTEM, WHILE EXACERBATING OTHERS. THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE (NYC DOHMH) PLANS TO IMPROVE ITS SYSTEMS AND OPERATIONS IN ORDER TO MEET THE VARIED AND COMPLEX NEEDS OF NYC\u2019S POPULATION, PARTICULARLY FOLLOWING OVER 2.5 YEARS OF RESPONDING TO COVID-19.  DOHMH PLANS TO STRENGTHEN ITS PARTNERSHIPS AND ITS INVESTMENTS IN COMMUNITIES BY HIRING, RETAINING, SUSTAINING, AND TRAINING THE PUBLIC HEALTH WORKFORCE AND BY INVESTING IN KEY, STRATEGIC COMPONENTS OF AGENCY AND CITY INFRASTRUCTURE, INCLUDING DOHMH\u2019S FOUNDATIONAL CAPABILITIES SUCH AS INFORMATION TECHNOLOGY, HUMAN RESOURCES, FINANCIAL MANAGEMENT, COMMUNICATIONS, AND CONTRACT AND PROCUREMENT SERVICES. DOHMH WILL ALSO INVEST IN DATA MODERNIZATION STRATEGICALLY IN ORDER TO EXPAND, IMPROVE, AND ACCELERATE PUBLIC HEALTH SERVICES AND, IN TURN, BETTER ADDRESS PUBLIC HEALTH CONCERNS, INCLUDING COVID-19.  DOHMH EXPECTS TO ACHIEVE THE FOLLOWING OUTCOMES: -\tINCREASED HIRING OF DIVERSE STAFF; INCREASED SIZE AND CAPABILITIES OF THE PUBLIC HEALTH WORKFORCE WITH IMPROVED WAGES AND PROTECTIONS -\tIMPROVED ORGANIZATIONAL SYSTEMS AND PROCESSES; STRENGTHENED FOUNDATIONAL PUBLIC HEALTH CAPABILITIES -\tA MORE MODERN AND EFFICIENT DATA ENVIRONMENT; INCREASED DATA INTEROPERABILITY; INCREASED AVAILABILITY AND USE OF PUBLIC HEALTH DATA TO INFORM PROGRAMMING AND INVESTMENTS  FINALLY, GIVEN THE EXPEDIENCY WITH WHICH DOHMH PLANS TO RECEIVE AND EXPEND THESE FUNDS, DOHMH WILL UTILIZE A FISCAL AGENT, PUBLIC HEALTH SOLUTIONS, TO RECEIVE, OBLIGATE AND LIQUIDATE GRANT FUNDS ON DOHMH\u2019S BEHALF. THE RELATIONSHIP BETWEEN DOHMH AND PUBLIC HEALTH SOLUTIONS FOR MANAGEMENT OF GRANT FUNDS IN THE AREAS OF EMERGENCY PREPAREDNESS AND RESPONSE HAS RESULTED IN SIGNIFICANT EFFICIENCIES IN THE PROCUREMENT OF GOODS AND SERVICES, INCLUDING RAPID AND COMPLETE SPEND-DOWN OF AWARDS; AND DOHMH LOOKS TO ACHIEVE THE SAME EFFICIENCY IN MANAGEMENT OF THIS AWARD.","funder_award_id":"NE11OE000057","funder_id":"https://openalex.org/F4320332162","funder_display_name":"Centers for Disease Control and Prevention"}],"funders":[{"id":"https://openalex.org/F4320332162","display_name":"Centers for Disease Control and Prevention","ror":"https://ror.org/042twtr12"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7206202062.pdf","grobid_xml":"https://content.openalex.org/works/W7206202062.grobid-xml"},"referenced_works_count":33,"referenced_works":["https://openalex.org/W1975970108","https://openalex.org/W2112669742","https://openalex.org/W2149025975","https://openalex.org/W2155596333","https://openalex.org/W2204865864","https://openalex.org/W2418796996","https://openalex.org/W2470906689","https://openalex.org/W2748948055","https://openalex.org/W2789637533","https://openalex.org/W2892014817","https://openalex.org/W2995279343","https://openalex.org/W3158840448","https://openalex.org/W3208868404","https://openalex.org/W4291020004","https://openalex.org/W4310508485","https://openalex.org/W4323832999","https://openalex.org/W4386518485","https://openalex.org/W4388295262","https://openalex.org/W4391845604","https://openalex.org/W4400949293","https://openalex.org/W4401461906","https://openalex.org/W4403579295","https://openalex.org/W4404880964","https://openalex.org/W4406326085","https://openalex.org/W4407182247","https://openalex.org/W4409274965","https://openalex.org/W4409340739","https://openalex.org/W4409656551","https://openalex.org/W4409710458","https://openalex.org/W4410221801","https://openalex.org/W4413484980","https://openalex.org/W4417488445","https://openalex.org/W7132855439"],"related_works":["https://openalex.org/W4403579295","https://openalex.org/W4407157506","https://openalex.org/W4407338867","https://openalex.org/W7084764977","https://openalex.org/W7154169878","https://openalex.org/W4405975250","https://openalex.org/W4389815447","https://openalex.org/W3178617495","https://openalex.org/W4409054808","https://openalex.org/W4205536614"],"abstract_inverted_index":{"Abstract":[0],"Objective":[1],"To":[2],"estimate":[3],"the":[4,52,86],"prevalence":[5,70,97,129,158],"of":[6,28,33,88,98,139,159],"Post-Exertional":[7],"Malaise":[8],"(PEM)":[9],"among":[10,132,199],"adults":[11,35],"with":[12,36,51,90,106,152,179],"prior":[13,37],"COVID-19":[14,38],"and":[15,19,76,93,104,118,135,141,163,176,181,189],"associated":[16,151,178],"mental":[17,160,183],"health":[18,161],"disability":[20,169,180],"outcomes.":[21],"Methods":[22],"We":[23],"conducted":[24],"a":[25,31,123],"cross-sectional":[26],"analysis":[27],"data":[29],"from":[30],"survey":[32],"9,620":[34],"in":[39],"New":[40,115],"York":[41],"City,":[42],"collected":[43],"May":[44],"\u2013":[45,56],"June":[46],"2024.":[47],"PEM":[48,89,99,128,149,172],"was":[49,82,101,130,150],"measured":[50],"DePaul":[53],"Symptom":[54],"Questionnaire":[55],"Post":[57],"Exertional":[58],"Malaise,":[59],"categorized":[60],"by":[61,74],"symptom":[62,107],"duration":[63,108],"(<":[64],"14":[65,110],"vs.":[66],"\u226514":[67],"hours).":[68],"Weighted":[69],"estimates":[71],"were":[72,174],"stratified":[73],"socio-demographic":[75],"clinical":[77],"characteristics.":[78],"Modified":[79],"Poisson":[80],"regression":[81],"used":[83],"to":[84,187,194],"assess":[85],"association":[87],"depression,":[91],"anxiety,":[92],"disability.":[94],"Results":[95],"The":[96],"symptoms":[100,173],"20.9%":[102],"overall":[103],"4.0%":[105],"\u2265":[109],"hours,":[111],"representing":[112],"over":[113,119],"800,000":[114],"Yorkers":[116],"affected":[117],"150,000":[120],"who":[121],"meet":[122],"diagnostic":[124],"criterion":[125],"for":[126],"ME/CFS.":[127],"higher":[131,157,168],"women,":[133],"transgender":[134],"non-binary":[136],"adults,":[137],"people":[138],"color,":[140],"lower":[142],"educational":[143],"attainment,":[144],"chronic":[145],"comorbidities,":[146],"or":[147],"disabilities.":[148],"3":[153],"-":[154,165],"4":[155,164],"times":[156,167],"outcomes":[162],"5":[166],"scores.":[170],"Conclusions":[171],"common":[175],"strongly":[177],"adverse":[182],"health.":[184],"Screening,":[185],"pathways":[186],"care,":[188],"supportive":[190],"policies":[191],"are":[192],"needed":[193],"mitigate":[195],"long-term":[196],"consequences,":[197],"particularly":[198],"marginalized":[200],"populations.":[201]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-09-03T00:00:00"}