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Yeah, okay, I'm calling bullshit.
Elira's playthrough of Metal Gear is completely staged, scripted specifically by Pomu. Elira's coughing? It's all been planned by Pomu as a Checkov's Gun. Elira's cough will be resolved during the MGS4 playthrough, specifically in the finale when Pomu, like Big Boss, interrupts the stream when Snake is at the graveyard and turns it into a surprise off-collab. I don't know how MGSV ties into this but I promise you it's no coincidence that the most recent debuts in NijiEN are a man with a plague doctor mask and a woman who idolizes Pomu.
>t-take your meds anon
I've already taken 6,000mg of medically prescribed Lithium.