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More than a year after COVID-19 emerged, many mysteries persist about the disease: why do some people get so much sicker than others? Why does lung damage sometimes continue to worsen well after the body seems to have cleared the SARS-CoV-2 virus? And what is behind the extended, multi-organ illness that lasts for months in people with 'long COVID'? A growing number of studies suggest that some of these questions might be explained by the immune system mistakenly turning against the body - a phenomenon known as autoimmunity.

But when cognitive science turned its back on behaviourism more than 50 years ago and began dealing with signals and internal maps, goals and expectations, beliefs and desires, biologists were torn. All right, they conceded, people and some animals have minds; their brains are physical minds - not mysterious dualistic minds - processing information and guiding purposeful behaviour; animals without brains, such as sea squirts, don't have minds, nor do plants or fungi or microbes. They resisted introducing intentional idioms into their theoretical work, except as useful metaphors when teaching or explaining to lay audiences. Genes weren't really selfish, antibodies weren't really seeking, cells weren't really figuring out where they were. These little biological mechanisms weren't really agents with agendas, even though thinking of them as if they were often led to insights.

Common Cold Study and others like it, while scrambling to understand the human immune response to SARS-CoV-2 using animals and cell cultures, along with the latest molecular techniques. They have catalogued antibody and immune-cell responses with uncommon speed, determined which are likely to be the most effective, and designed vaccines and therapies that, in animal studies and small human studies, provoke at least short-term immune responses. But there is no quick and simple experiment that can firmly determine whether immunity will be effective or lasting. It is just too soon to know.

Clinical suspicion and indicated SARS-CoV-2 testing, including antibody testing, might be needed to recognize and treat adults with MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this condition. Ultimately, the recognition of MIS-A reinforces the need for prevention efforts to limit spread of SARS-CoV-2. COVID-19