Long COVID isn’t going away, and we still do not have a way to fully prevent it, cure it, or really to quantify it.
The world was slow to recognize long COVID as one of the most serious consequences of the coronavirus. Six months into the pathogen’s tear across the globe, SARS-CoV-2 was still considered an acute airway infection that would spark a weeks-long illness at most; anyone who experienced symptoms for longer could be expected to be dismissed by droves of doctors. Now long COVID is written into CDC and WHO documents; it makes a cameo in the newest version of President Joe Biden’s National COVID-19 Preparedness Plan.
But for all we knownowabout long COVID, it is still not enough. Researchers still don’t know who’s most at risk, or how long the condition might last; whether certain variants might cause it more frequently, or the extent to which vaccines might sweep it away. We do not have a way to fully prevent it. We do not have a way to cure it. We don’t even have a way to really quantify it: There still isn’t consensus on how common long COVID actually is. Its danger feels both amorphous and unavoidable. People already struggle to deal with well-known risks, let alone fuzzy, slippery ones. “You can be too afraid of what you don’t understand or just say, ‘It’s not well defined; I’m not going to think about it,’” says Erin Sanders, a nurse practitioner and clinical scientist at MIT. Concern, when we let it, can act like a gas. It expands to fill the space we give it.
But even if long COVID’s prevalence turns out to be a single-digit percentage of SARS-CoV-2 infections—proportionally much smaller than most experts estimate—in absolute terms “that is not small,” says Ziyad Al-Aly, the director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System. Millions of people have already developed long COVID; many of them, an untold fraction, have not recovered. This is the challenge of chronic illness: When people join its ranks, they do not always exit. With each new case of long COVID, the virus’s burden balloons.
“I worry, now that everyone is moving to the post-pandemic world, we’re going to sweep all these patients under the rug,” Al-Aly said. Long COVID struggled to gain a toehold in the national consciousness; now it threatens to be one of the first major COVID impacts to slip back into the margins.
Researchers have known for many months that long COVID is more a category than a monolith. Al-Aly very roughly likens it to the way we talk about cancer—an umbrella term for diseases that are related but that require distinct diagnoses and treatments. Long COVID has hundreds of possible symptoms. It can batter the brain, the heart, the lungs, the gut, all of the above, or none of the above. The condition can start from a silent infection, an ICU-caliber case, or anything in between. It can begin days, weeks, or months after the virus first infects someone, and its severity can fluctuate over time. “We lump all of that into one broad thing,” Al-Aly said. “It is not.”
The condition’s root causes, accordingly, are also diverse. In some cases, long COVID may be collateral damage from the war waged between virus and immune system; in others, it might sprout out of a chronic SARS-CoV-2 infection or, conversely, a quick viral encounter that sets bodily systems on the fritz. These hypotheses aren’t comprehensive or mutually exclusive: There are only so many ways for bodies to run smoothly, and infinite ways to throw those processes out of whack.
All of this means that even diagnosing long COVID—an essential step toward understanding it—is still a battle. We don’t have a clear-cut, consensus clinical definition, a single name for the condition, or a standardized set of tests to catch it. Even the CDC and the WHO can’t agree on how long a person must be sick before they meet the condition’s criteria. Some researchers and health-care providers favor one agency’s definition; others, dissatisfied with both, come up with their own. And “there are still doctors out there that do not think long COVID exists,” says Alexandra Yonts, a pediatric-infectious-disease specialist at Children’s National Hospital, in Washington, D.C.
In an ideal experimental world, to understand long COVID’s risks, researchers would systematically survey large swaths of the population over long periods of time, watching to see who gets infected, who goes on to develop the condition, what form it takes, and how it impacts people’s health, says Shruti Mehta, an infectious-disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health who is studying long COVID. But few institutions have the resources for such an undertaking, which could span many months or years. So many researchers have to make do with the limited data sets that are already available to them. As a result, some studies end up biased toward patients who were hospitalized, while others wind up favoring people who have the time, means, and trust in the health-care system to sign up for long-term studies. Neither group fully captures long COVID’s wide-ranging toll. The situation’s especially tough for pediatric patients, who might be too young to articulate the severity of their symptoms and are often excluded from long-COVID studies. Long COVID certainly exists in kids, but it may not perfectly mirror what goes on in adults: Children’s susceptibility to the virus is different, and their bodies are so rapidly changing, says Yonts, who runs a pediatric-long-COVID clinic in D.C.
All told, the study of long COVID has become, as Sanders of MIT puts it, “a data disaster.” Some researchers estimate that a single-digit percentage of SARS-CoV-2 infections bloom into long COVID; Al-Aly is one of them. Others, meanwhile, favor larger numbers, with a few even insisting that the rates are actually more than half. Most of the experts said they feel comfortable working in the 10 to30 percent range, which is where many studies seem to be starting to converge. Finding one answer is tricky, without knowing how many forms long COVID can take—some could be more common than others. Formally splitting the disease into subdivisions could help address some of these ambiguities. But we don’t know nearly enough to start slicing and dicing, says Bryan Lau, an infectious-disease epidemiologist working with Mehta and Priya Duggal.
If researchers aren’t comprehensively capturing who currently has long COVID, they can’t say for certain who’s most likely to get it either. Manyresearchershavefound that women contract long COVID more frequently than men. Others have uncovered evidence that people who end up infected with gobs of the coronavirus, or who produce antibodies that attack the body’s own tissues, also seem to tilt toward long COVID. Chronic health issues, including diabetes, could up a person’s chances of getting sick and staying sick as well. So might a lingering Epstein-Barr virus infection. But some of these trends are still being confirmed, experts said, and the extent to which they toggle risk up or down isn’t known. And it’s definitely too early to pinpoint any of these factors as long-COVID causes. “For acute COVID, we know what the risk factors are,” Akiko Iwasaki, an immunologist studying long COVID at Yale, said. “For long COVID, it’s much less clear.”
Still, a couple of other variables feel a bit more nailed down. “The riskishigh in people who need hospitalization or ICU care,” Al-Aly said. Deepti Gurdasani, an epidemiologist at Queen Mary University of London, says she’s fairly confident that the nature of a person’s exposure to SARS-CoV-2 plays a role as well: Heavier and more frequent viral encounters seem to tip the scales toward symptoms that last and last. That’s a concern for people in essential occupations, who “aren’t able to shield themselves,” she said.
If these last few factors directly affect how and whether long COVID unspools, vaccination—which reliably staves off hospitalization and, to a lesser degree, infection—could be a partial preventive. Severalstudies have shown that shots do seem to muzzle long-COVID rates. They don’t, however, eliminate long COVID’s odds. To date, experts have yet to find any demographic that has been spared from the condition, despite persistent myths that certain groups, particularly kids, are somehow immune. “We’ve seen it in children of all ages,” says Laura Malone, a pediatric neurologist at the Kennedy Krieger Institute, in Baltimore. Some of her patients are toddlers. The virus isn’t pulling any punches either. Every iteration we’ve encountered so far, Omicron included, seems capable of causing long COVID. “No one is not at risk,” Al-Aly said.
To this day, most countries do not keep a running tally of long-COVID cases. But ballparks of the burden are staggering. Some 2 percent of all U.K. residents—not just those with documented infections—might currently have long COVID, according to the Office for National Statistics. Another analysis estimates that up to 23 million Americans have developed the condition since the pandemic’s start. More will join them. But Davis worries that those numbers will continue to be left off of national dashboards, and thus out of the public eye. Now that the federal government has tightened the boundaries of its concern to hospitalizations and deaths, the public does not even really have to look away from the national perspective on long COVID: There is next to nothing to see.
As people rack up different combinations of shots and infections with different variants, what worsens or soothes long COVID is also getting harder to understand. Many of the experts think long COVID is essential to study, it’s too complex for them to want to tackle themselves. Meanwhile, long COVID remains the pandemic’s looming specter. We are told there is risk, but not exactly how much; we are told that avoiding long COVID would be ideal, but lack the practical guidance to do so—the virus is so widespread that eventual infection, for many people, feels almost inevitable.
At the same time, as researchers look deeper and deeper into the bodies of infected people, they’re only seeing more damage. With each passing month, more studies emerge documenting how the coronavirus alters the function of vital organs such as the heart and the brain. The public has been cultured to think that most SARS-CoV-2 infections are trivial, and the repercussions brief, especially for the young, healthy, and privileged. But long COVID breaks the binary of severe and mild. “It’s going to continue to affect people, even people who are protected from severe illness during the acute phase of infection,” Michael Peluso, an infectious-disease physician and long-COVID researcher at UC San Francisco, said.
No matter where the true numbers on long-COVID risk sit, they are too large to ignore. “Whether it’s 10 percent or 50 percent, at both levels you have to do something about it,” Gurdasani said. Statistics will help sharpen and clarify the condition’s boundaries, and are still worth seeking out. They will not, however, change long COVID’s threat, at its core.
Davis, who is nearing her second anniversary of developing long COVID, feels this deeply. She is still experiencing cognitive dysfunction and memory loss. Her heart still races when she stands. “You cannot live your life like you used to,” she said. “Your life just becomes this shell.” For individuals, for societies, “this is not going away.” Even after much of the world puts the pandemic in its rearview, long COVID will keep filling hospitals and clinics. It will dot the pages of scientific texts, and linginfer in the bodies of millions of people worldwide. Hospitalizations and ICU admissions are not the only COVID outcomes that can buckle a health-care system.
That strain is already being felt by the health-care workers on long COVID’s front lines. Yonts, the Children’s National pediatrician, said that she’s currently booking patients “out to Memorial Day.” COVID’s global crisis can, in some ways, end when we decide to treat it as done. But that is not an option for a growing fraction of the planet, who cannot put COVID fully behind them. “This is going to be the pandemic after the pandemic,” Gurdasani said.
Cognitive impairment as a result of severe COVID-19 is similar to that sustained between 50 and 70 years of age and is the equivalent to losing 10 IQ points, say a team of scientists from the University of Cambridge and Imperial College London.
The findings, published in the journal eClinicalMedicine, emerge from the NIHR COVID-19 BioResource. The results of the study suggest the effects are still detectable more than six months after the acute illness, and that any recovery is at best gradual.
There is growing evidence that COVID-19 can cause lasting cognitive and mental health problems, with recovered patients reporting symptoms including fatigue, ‘brain fog’, problems recalling words, sleep disturbances, anxiety and even post-traumatic stress disorder (PTSD) months after infection. In the UK, a study found that around one in seven individuals surveyed reported having symptoms that included cognitive difficulties 12 weeks after a positive COVID-19 test.
To explore this link in greater detail, researchers analysed data from 46 individuals who received in-hospital care, on the ward or intensive care unit, for COVID-19 at Addenbrooke’s Hospital, part of Cambridge University Hospitals NHS Foundation Trust. 16 patients were put on mechanical ventilation during their stay in hospital. All the patients were admitted between March and July 2020 and were recruited to the NIHR COVID-19 BioResource.
The individuals underwent detailed computerised cognitive tests an average of six months after their acute illness using the Cognitron platform, which measures different aspects of mental faculties such as memory, attention and reasoning. Scales measuring anxiety, depression and post-traumatic stress disorder were also assessed. Their data were compared against matched controls.
This is the first time that such rigorous assessment and comparison has been carried out in relation to the after effects of severe COVID-19.
COVID-19 survivors were less accurate and with slower response times than the matched control population – and these deficits were still detectable when the patients were following up six months later. The effects were strongest for those who required mechanical ventilation. By comparing the patients to 66,008 members of the general public, the researchers estimate that the magnitude of cognitive loss is similar on average to that sustained with 20 years ageing, between 50 and 70 years of age, and that this is equivalent to losing 10 IQ points.
Survivors scored particularly poorly on tasks such as verbal analogical reasoning, a finding that supports the commonly-reported problem of difficulty finding words. They also showed slower processing speeds, which aligns with previous observations post COVID-19 of decreased brain glucose consumption within the frontoparietal network of the brain, responsible for attention, complex problem-solving and working memory, among other functions.
Professor David Menon from the Division of Anaesthesia at the University of Cambridge, the study’s senior author, said: “Cognitive impairment is common to a wide range of neurological disorders, including dementia, and even routine ageing, but the patterns we saw – the cognitive ‘fingerprint’ of COVID-19 – was distinct from all of these.”
While it is now well established that people who have recovered from severe COVID-19 illness can have a broad spectrum of symptoms of poor mental health – depression, anxiety, post-traumatic stress, low motivation, fatigue, low mood, and disturbed sleep – the team found that acute illness severity was better at predicting the cognitive deficits.
The patients’ scores and reaction times began to improve over time, but the researchers say that any recovery in cognitive faculties was at best gradual and likely to be influenced by a number of factors including illness severity and its neurological or psychological impacts.
Professor Menon added: “We followed some patients up as late as ten months after their acute infection, so were able to see a very slow improvement. While this was not statistically significant, it is at least heading in the right direction, but it is very possible that some of these individuals will never fully recover.”
There are several factors that could cause the cognitive deficits, say the researchers. Direct viral infection is possible, but unlikely to be a major cause; instead, it is more likely that a combination of factors contribute, including inadequate oxygen or blood supply to the brain, blockage of large or small blood vessels due to clotting, and microscopic bleeds. However, emerging evidence suggests that the most important mechanism may be damage caused by the body’s own inflammatory response and immune system.
While this study looked at hospitalised cases, the team say that even those patients not sick enough to be admitted may also have tell-tale signs of mild impairment.
Professor Adam Hampshire from the Department of Brain Sciences at Imperial College London, the study’s first author, said: “Around 40,000 people have been through intensive care with COVID-19 in England alone and many more will have been very sick, but not admitted to hospital. This means there is a large number of people out there still experiencing problems with cognition many months later. We urgently need to look at what can be done to help these people.”
The intruder stalks its prey with stealth and precision, preparing to puncture its quarry’s armor. Once inside, the aggressor forces its host to produce more intruders, and then causes it to explode, spewing out a multitude of invaders who can continue their rampage on a wider scale.
The drama, depicted in a microscopic video of SARS-CoV-2 infecting bat brain cells, provides a window into how the pathogen turns cells into virus-making factories before causing the host cell to die.
The video was produced by Sophie-Marie Aicher and Delphine Planas, virologists at the Pasteur Institute in Paris who won honorable mention in a microscopic video competition sponsored by Nikon, the photography company.
Filmed over 48 hours with an image recorded every 10 minutes, the footage shows the coronavirus as red spots circulating among a mass of gray blobs — the bat’s brain cells. After they are infected, the bat’s cells begin to fuse with neighboring cells. At some point, the entire mass bursts, resulting in the death of the cells.
Ms. Aicher, who specializes in zoonotic diseases — those that can be transmitted from animals to humans — said this infectious juggernaut was the same in bats and humans, with one important distinction: Bats ultimately do not get sick.
In humans, the coronavirus is able to evade detection and cause more damage in part by preventing infected cells from alerting the immune system to the presence of the invaders. But its special power is the ability to force host cells to fuse with neighboring ones, a process known as syncytia that allows the coronavirus to remain undetected as it replicates.
“Every time the virus has to exit the cell, it’s at risk of detection so if it can go straight from one cell to another, it can work much faster,” Ms. Aicher said.
She said she hoped the video would help demystify the virus, and make it easier for people to understand and appreciate this deceitful nemesis that has upended billions of lives.
“It’s important to help people get past the scientific jargon to understand that this a very sophisticated and clever virus that is well adapted to make humans sick,” she said.
Video description & credit: A microscopic video shows the coronavirus causing cell fusion and death in bat brain cells. This video received honorable mention in the 2021 Nikon Small World in Motion Competition. Sophie-Marie Aicher & Dr. Delphine Planas.
Cognitive impairment as a result of severe COVID-19 is similar to that sustained between 50 and 70 years of age and is the equivalent to losing 10 IQ points, say a team of scientists from the University of Cambridge and Imperial College London.
The findings, published in the journal eClinicalMedicine, emerge from the NIHR COVID-19 BioResource. The results of the study suggest the effects are still detectable more than six months after the acute illness, and that any recovery is at best gradual.
There is growing evidence that COVID-19 can cause lasting cognitive and mental health problems, with recovered patients reporting symptoms including fatigue, ‘brain fog’, problems recalling words, sleep disturbances, anxiety and even post-traumatic stress disorder (PTSD) months after infection. In the UK, a study found that around one in seven individuals surveyed reported having symptoms that included cognitive difficulties 12 weeks after a positive COVID-19 test.
To explore this link in greater detail, researchers analysed data from 46 individuals who received in-hospital care, on the ward or intensive care unit, for COVID-19 at Addenbrooke’s Hospital, part of Cambridge University Hospitals NHS Foundation Trust. 16 patients were put on mechanical ventilation during their stay in hospital. All the patients were admitted between March and July 2020 and were recruited to the NIHR COVID-19 BioResource.
The individuals underwent detailed computerised cognitive tests an average of six months after their acute illness using the Cognitron platform, which measures different aspects of mental faculties such as memory, attention and reasoning. Scales measuring anxiety, depression and post-traumatic stress disorder were also assessed. Their data were compared against matched controls.
This is the first time that such rigorous assessment and comparison has been carried out in relation to the after effects of severe COVID-19.
COVID-19 survivors were less accurate and with slower response times than the matched control population – and these deficits were still detectable when the patients were following up six months later. The effects were strongest for those who required mechanical ventilation. By comparing the patients to 66,008 members of the general public, the researchers estimate that the magnitude of cognitive loss is similar on average to that sustained with 20 years ageing, between 50 and 70 years of age, and that this is equivalent to losing 10 IQ points.
Survivors scored particularly poorly on tasks such as verbal analogical reasoning, a finding that supports the commonly-reported problem of difficulty finding words. They also showed slower processing speeds, which aligns with previous observations post COVID-19 of decreased brain glucose consumption within the frontoparietal network of the brain, responsible for attention, complex problem-solving and working memory, among other functions.
Professor David Menon from the Division of Anaesthesia at the University of Cambridge, the study’s senior author, said: “Cognitive impairment is common to a wide range of neurological disorders, including dementia, and even routine ageing, but the patterns we saw – the cognitive ‘fingerprint’ of COVID-19 – was distinct from all of these.”
While it is now well established that people who have recovered from severe COVID-19 illness can have a broad spectrum of symptoms of poor mental health – depression, anxiety, post-traumatic stress, low motivation, fatigue, low mood, and disturbed sleep – the team found that acute illness severity was better at predicting the cognitive deficits.
The patients’ scores and reaction times began to improve over time, but the researchers say that any recovery in cognitive faculties was at best gradual and likely to be influenced by a number of factors including illness severity and its neurological or psychological impacts.
Professor Menon added: “We followed some patients up as late as ten months after their acute infection, so were able to see a very slow improvement. While this was not statistically significant, it is at least heading in the right direction, but it is very possible that some of these individuals will never fully recover.”
There are several factors that could cause the cognitive deficits, say the researchers. Direct viral infection is possible, but unlikely to be a major cause; instead, it is more likely that a combination of factors contribute, including inadequate oxygen or blood supply to the brain, blockage of large or small blood vessels due to clotting, and microscopic bleeds. However, emerging evidence suggests that the most important mechanism may be damage caused by the body’s own inflammatory response and immune system.
While this study looked at hospitalised cases, the team say that even those patients not sick enough to be admitted may also have tell-tale signs of mild impairment.
Professor Adam Hampshire from the Department of Brain Sciences at Imperial College London, the study’s first author, said: “Around 40,000 people have been through intensive care with COVID-19 in England alone and many more will have been very sick, but not admitted to hospital. This means there is a large number of people out there still experiencing problems with cognition many months later. We urgently need to look at what can be done to help these people.”
Long COVID isn’t going away, and we still do not have a way to fully prevent it, cure it, or really to quantify it.
The world was slow to recognize long COVID as one of the most serious consequences of the coronavirus. Six months into the pathogen’s tear across the globe, SARS-CoV-2 was still considered an acute airway infection that would spark a weeks-long illness at most; anyone who experienced symptoms for longer could be expected to be dismissed by droves of doctors. Now long COVID is written into CDC and WHO documents; it makes a cameo in the newest version of President Joe Biden’s National COVID-19 Preparedness Plan.
But for all we knownowabout long COVID, it is still not enough. Researchers still don’t know who’s most at risk, or how long the condition might last; whether certain variants might cause it more frequently, or the extent to which vaccines might sweep it away. We do not have a way to fully prevent it. We do not have a way to cure it. We don’t even have a way to really quantify it: There still isn’t consensus on how common long COVID actually is. Its danger feels both amorphous and unavoidable. People already struggle to deal with well-known risks, let alone fuzzy, slippery ones. “You can be too afraid of what you don’t understand or just say, ‘It’s not well defined; I’m not going to think about it,’” says Erin Sanders, a nurse practitioner and clinical scientist at MIT. Concern, when we let it, can act like a gas. It expands to fill the space we give it.
But even if long COVID’s prevalence turns out to be a single-digit percentage of SARS-CoV-2 infections—proportionally much smaller than most experts estimate—in absolute terms “that is not small,” says Ziyad Al-Aly, the director of the Clinical Epidemiology Center at the Veterans Affairs St. Louis Health Care System. Millions of people have already developed long COVID; many of them, an untold fraction, have not recovered. This is the challenge of chronic illness: When people join its ranks, they do not always exit. With each new case of long COVID, the virus’s burden balloons.
“I worry, now that everyone is moving to the post-pandemic world, we’re going to sweep all these patients under the rug,” Al-Aly said. Long COVID struggled to gain a toehold in the national consciousness; now it threatens to be one of the first major COVID impacts to slip back into the margins.
Researchers have known for many months that long COVID is more a category than a monolith. Al-Aly very roughly likens it to the way we talk about cancer—an umbrella term for diseases that are related but that require distinct diagnoses and treatments. Long COVID has hundreds of possible symptoms. It can batter the brain, the heart, the lungs, the gut, all of the above, or none of the above. The condition can start from a silent infection, an ICU-caliber case, or anything in between. It can begin days, weeks, or months after the virus first infects someone, and its severity can fluctuate over time. “We lump all of that into one broad thing,” Al-Aly said. “It is not.”
The condition’s root causes, accordingly, are also diverse. In some cases, long COVID may be collateral damage from the war waged between virus and immune system; in others, it might sprout out of a chronic SARS-CoV-2 infection or, conversely, a quick viral encounter that sets bodily systems on the fritz. These hypotheses aren’t comprehensive or mutually exclusive: There are only so many ways for bodies to run smoothly, and infinite ways to throw those processes out of whack.
All of this means that even diagnosing long COVID—an essential step toward understanding it—is still a battle. We don’t have a clear-cut, consensus clinical definition, a single name for the condition, or a standardized set of tests to catch it. Even the CDC and the WHO can’t agree on how long a person must be sick before they meet the condition’s criteria. Some researchers and health-care providers favor one agency’s definition; others, dissatisfied with both, come up with their own. And “there are still doctors out there that do not think long COVID exists,” says Alexandra Yonts, a pediatric-infectious-disease specialist at Children’s National Hospital, in Washington, D.C.
In an ideal experimental world, to understand long COVID’s risks, researchers would systematically survey large swaths of the population over long periods of time, watching to see who gets infected, who goes on to develop the condition, what form it takes, and how it impacts people’s health, says Shruti Mehta, an infectious-disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health who is studying long COVID. But few institutions have the resources for such an undertaking, which could span many months or years. So many researchers have to make do with the limited data sets that are already available to them. As a result, some studies end up biased toward patients who were hospitalized, while others wind up favoring people who have the time, means, and trust in the health-care system to sign up for long-term studies. Neither group fully captures long COVID’s wide-ranging toll. The situation’s especially tough for pediatric patients, who might be too young to articulate the severity of their symptoms and are often excluded from long-COVID studies. Long COVID certainly exists in kids, but it may not perfectly mirror what goes on in adults: Children’s susceptibility to the virus is different, and their bodies are so rapidly changing, says Yonts, who runs a pediatric-long-COVID clinic in D.C.
All told, the study of long COVID has become, as Sanders of MIT puts it, “a data disaster.” Some researchers estimate that a single-digit percentage of SARS-CoV-2 infections bloom into long COVID; Al-Aly is one of them. Others, meanwhile, favor larger numbers, with a few even insisting that the rates are actually more than half. Most of the experts said they feel comfortable working in the 10 to30 percent range, which is where many studies seem to be starting to converge. Finding one answer is tricky, without knowing how many forms long COVID can take—some could be more common than others. Formally splitting the disease into subdivisions could help address some of these ambiguities. But we don’t know nearly enough to start slicing and dicing, says Bryan Lau, an infectious-disease epidemiologist working with Mehta and Priya Duggal.
If researchers aren’t comprehensively capturing who currently has long COVID, they can’t say for certain who’s most likely to get it either. Manyresearchershavefound that women contract long COVID more frequently than men. Others have uncovered evidence that people who end up infected with gobs of the coronavirus, or who produce antibodies that attack the body’s own tissues, also seem to tilt toward long COVID. Chronic health issues, including diabetes, could up a person’s chances of getting sick and staying sick as well. So might a lingering Epstein-Barr virus infection. But some of these trends are still being confirmed, experts said, and the extent to which they toggle risk up or down isn’t known. And it’s definitely too early to pinpoint any of these factors as long-COVID causes. “For acute COVID, we know what the risk factors are,” Akiko Iwasaki, an immunologist studying long COVID at Yale, said. “For long COVID, it’s much less clear.”
Still, a couple of other variables feel a bit more nailed down. “The riskishigh in people who need hospitalization or ICU care,” Al-Aly said. Deepti Gurdasani, an epidemiologist at Queen Mary University of London, says she’s fairly confident that the nature of a person’s exposure to SARS-CoV-2 plays a role as well: Heavier and more frequent viral encounters seem to tip the scales toward symptoms that last and last. That’s a concern for people in essential occupations, who “aren’t able to shield themselves,” she said.
If these last few factors directly affect how and whether long COVID unspools, vaccination—which reliably staves off hospitalization and, to a lesser degree, infection—could be a partial preventive. Severalstudies have shown that shots do seem to muzzle long-COVID rates. They don’t, however, eliminate long COVID’s odds. To date, experts have yet to find any demographic that has been spared from the condition, despite persistent myths that certain groups, particularly kids, are somehow immune. “We’ve seen it in children of all ages,” says Laura Malone, a pediatric neurologist at the Kennedy Krieger Institute, in Baltimore. Some of her patients are toddlers. The virus isn’t pulling any punches either. Every iteration we’ve encountered so far, Omicron included, seems capable of causing long COVID. “No one is not at risk,” Al-Aly said.
To this day, most countries do not keep a running tally of long-COVID cases. But ballparks of the burden are staggering. Some 2 percent of all U.K. residents—not just those with documented infections—might currently have long COVID, according to the Office for National Statistics. Another analysis estimates that up to 23 million Americans have developed the condition since the pandemic’s start. More will join them. But Davis worries that those numbers will continue to be left off of national dashboards, and thus out of the public eye. Now that the federal government has tightened the boundaries of its concern to hospitalizations and deaths, the public does not even really have to look away from the national perspective on long COVID: There is next to nothing to see.
As people rack up different combinations of shots and infections with different variants, what worsens or soothes long COVID is also getting harder to understand. Many of the experts think long COVID is essential to study, it’s too complex for them to want to tackle themselves. Meanwhile, long COVID remains the pandemic’s looming specter. We are told there is risk, but not exactly how much; we are told that avoiding long COVID would be ideal, but lack the practical guidance to do so—the virus is so widespread that eventual infection, for many people, feels almost inevitable.
At the same time, as researchers look deeper and deeper into the bodies of infected people, they’re only seeing more damage. With each passing month, more studies emerge documenting how the coronavirus alters the function of vital organs such as the heart and the brain. The public has been cultured to think that most SARS-CoV-2 infections are trivial, and the repercussions brief, especially for the young, healthy, and privileged. But long COVID breaks the binary of severe and mild. “It’s going to continue to affect people, even people who are protected from severe illness during the acute phase of infection,” Michael Peluso, an infectious-disease physician and long-COVID researcher at UC San Francisco, said.
No matter where the true numbers on long-COVID risk sit, they are too large to ignore. “Whether it’s 10 percent or 50 percent, at both levels you have to do something about it,” Gurdasani said. Statistics will help sharpen and clarify the condition’s boundaries, and are still worth seeking out. They will not, however, change long COVID’s threat, at its core.
Davis, who is nearing her second anniversary of developing long COVID, feels this deeply. She is still experiencing cognitive dysfunction and memory loss. Her heart still races when she stands. “You cannot live your life like you used to,” she said. “Your life just becomes this shell.” For individuals, for societies, “this is not going away.” Even after much of the world puts the pandemic in its rearview, long COVID will keep filling hospitals and clinics. It will dot the pages of scientific texts, and linginfer in the bodies of millions of people worldwide. Hospitalizations and ICU admissions are not the only COVID outcomes that can buckle a health-care system.
That strain is already being felt by the health-care workers on long COVID’s front lines. Yonts, the Children’s National pediatrician, said that she’s currently booking patients “out to Memorial Day.” COVID’s global crisis can, in some ways, end when we decide to treat it as done. But that is not an option for a growing fraction of the planet, who cannot put COVID fully behind them. “This is going to be the pandemic after the pandemic,” Gurdasani said.
I wanted to capture my feelings as a doctor in training who has been bludgeoned by the Covid-19 pandemic the last year and a half. But I’ve been too burned out to write about burnout.”
This article captures the emotions that have kept me from trying to write anything substantial about the pandemic, the massive systemic failures involved, and the social selfishness/ignorance it has revealed.
Wouldn’t it be nice if we could erase disease with these happy organ erasers? Sadly the only two diseases to be eradicated worldwide are smallpox and rinderpest. We are still working to get rid of polio, yaws, dracunculiasis, malaria and so many more.
If you had magic powers, what disease or condition would you choose to wipe off the face of the Earth?
Wearing a face mask takes some getting used to. To get the most benefit, you need to avoid these common mistakes.
Masks in a variety of colors, styles and materials have appeared on the faces of people around us. While it’s good news that many people are doing their part to slow the spread of coronavirus, the bad news is that many people are wearing their masks wrong.
“Wearing a mask takes some getting used to, for sure,” said Dr. Scott Segal, chairman of anesthesiology at Wake Forest Baptist Health. “You are probably wearing it exactly right if it’s a little stuffy.”
One of the biggest mistakes people make is that they fidget with their masks, and pull them under their noses or completely off their faces to rest under their chins. “You should absolutely not be pulling up and putting down your mask while you’re out,” said Shan Soe-Lin, a lecturer at the Yale Jackson Institute for Global Affairs. “If you’re going to go to the trouble of using a mask, leave it on.”
Here are the dos and don’ts of wearing a mask.
And once you’ve figured out the correct position for wearing your mask, follow these tips to stay safe:
Always wash your hands before and after wearing a mask.
Use the ties or loops to put your mask on and pull it off.
Don’t touch the front of the mask when you take it off.
For apartment dwellers, put the mask on and remove it while inside your home. Elevators and stairwells can be high-contamination areas.
Wash and dry your cloth mask daily and keep it in a clean, dry place.
Don’t have a false sense of security.
Masks offer limited protection, and work better when combined with hand washing and social distancing. “It’s not that one excludes the other,” said Dr. Siddhartha Mukherjee, assistant professor of medicine at Columbia University. “They compound the effects of the other.”
Got my first dose of the Pfizer vaccine couple days ago!
My left arm throbbed for an hour, less than a flu shot – and then it calmed down to “tender only when bumped” (which the Cranquis Boys managed to bump regularly). No fatigue, headache, sore throat, not even a software update notification from Bill Gates.
Posted about it on Facebook (my first covid-related post in 8 months), offering to answer any serious questions about the vaccines “but randos spouting jibberish will be ignored”. Surprisingly, responses were positive!
50% people saying they can’t wait to get the vaccine
49% people with legit concerns based on various myths who wanted education to help them decide
1% some dude posting screen-shots from a French website that apparently “proves that mRNA turns humans into GMOs”… THAT was a fun block. :)
I’m glad healthcare workers are getting the vaccine first. NOT (just) because we are a limited resource that is vital to keeping our country alive while we trudge through this pandemic, and NOT (just) because it’s the least our country can do to acknowledge the sacrifices and strain we’ve endured (not gonna rant about politics not gonna rant about politics) – but because this gives us a vital opportunity to prove that we believe in vaccines.
There is tragically little leadership on convincing the public about vaccine safety (not – gonna – rant – about —) so we have to step up once again and educate our communities. We can do this, we’re trained for this, we’re putting it all on the line for this. The only hope we have for getting out of this nightmare is to achieve high levels of vaccinations.
(oh, and it goes without saying, right: anti-vaxx comments will be ignored, anti-vaxxers will be blocked)
This existential crisis has me cryin’ behind my eyelids. Someone asleep next to me, so my screams are only silent. Paranoia creepin’ in, got people feelin’ kinda violent. All because of selfish deeds from that orange tyrant.
I designated myself emergency manager of infection control, designed a pager schedule and protocol to guide new people through how to field COVID19 calls, worked on algorithms with our infection control practitioners, took samples to the lab for testing, returned calls from physicians and other healthcare providers on COVID risk stratification.
This was just today.
And we have four ID physicians and three hospital epidemiologists also on the phones answering calls from concerned healthcare workers, patients, and administrators.
Whatever happens, just remember: a strong public health response leads to calm, organized responses. Not this. Fuck Pence. Fuck Trump. Fuck all this shit.
If you work anywhere and interact with infectious diseases or infection control, please take time tomorrow to offer them a coffee, a kind word, buy them a snack. We need it right now.
So you’re probably like me: your family and friends see you’re in the medical profession. Or maybe you’re not in the medical profession but you’re pretty well read and you keep up with news. And they want to know if they should believe the panic. What’s accurate? What’s old? What’s new? What’s reliable?
I’ll tell you right now that keeping on top of the information itself has been an Olympic-level task unto itself.
This is not meant to be comprehensive, but designed for folks who need a few key, reliable resources to touch upon.
Those with NEJM access: Use it. The front page is doing a great COVID19 update every day, so check that out!
As an infectious diseases fellow working in the infection control division, I want to let you guys know that there’s so much I want to share with everyone but just not enough hours in the day to get it all in writing. I’m going to think about how best to get things out in a timely manner, but would love everyone’s suggestions and input for strategies to keep updates consistent without them being too time consuming and what kind of COVID19 content would help people right now.
