#*coronavirus

While public appetite for Covid news is low, experts say the stakes for communicating about respiratory illnesses are deceptively high. An ongoing bird flu outbreak and a small but deadly swine flu outbreak in Colombia this year have public health experts worried that another flu pandemic is all but assured in coming years. As government officials downplayed Covid, flu, and other deadly viruses in recent years—shortening Covid isolation times and lifting restrictions—misinformation about measles, another respiratory illness, has proliferated. A massive measles outbreak is currently roiling Europe, and Florida has now reported multiple cases at a single school. State officials who rose to prominence by opposing Covid measures said the 200 unvaccinated students who had been exposed did not need to quarantine.

Then there is the threat of more novel viruses; dangerous new coronaviruses have emerged every seven to nine years in the past two decades, which means we may be soon see another. In the meantime, Covid is still hospitalizing and killing people even with current guidelines; it could get worse when people are urged to move more freely while contagious.

In theory, we should be better equipped than ever before to counter these threats. “Covid has elevated the amount of access and information and awareness that we have [of] seasonal respiratory viruses,” said Erin Sorrell, senior scholar at the Johns Hopkins Center for Health Security. Covid taught us that these respiratory viruses can be airborne, that asymptomatic people can still infect others, and that the time it takes to stop shedding the virus can vary widely; we also learned what we can do to lessen these challenges.

“I’m about to cancel all my Zoom meetings.” It was May 2021, and Jamie Dimon had had enough. The JPMorgan Chase CEO expected that “sometime in September, October,” the company’s office would “look just like it did before.” Two years later, his company is slashing its Manhattan footprint by a fifth.

Post-pandemic, kids are back in school, retirees are back on cruise ships, and physical stores are doing better than expected. But offices are struggling perhaps more than most casual observers realize, and the consequences for landlords, banks, municipal governments, and even individual portfolios will be far-reaching. In some cases, they will be catastrophic. But this crisis, like all crises, also represents an opportunity to reconsider many of our assumptions about work and cities.

Three years since the beginning of the coronavirus pandemic in the US, the syndrome known as “long Covid” remains one of its chief mysteries.

Those mysteries include what the syndrome even is. The long-term fatigue and brain fog some people report after recovering from an acute infection are the symptoms most commonly associated with long Covid, but more than 200 distinct symptoms have been reported. The novel coronavirus may also change people’s cardiovascular systems permanently in ways that could lead to long-term health problems, even strokes and heart attacks. Is it all long Covid?

There are other elusive questions: How frequently do people get long Covid? Who is at the highest risk of developing it? And what is causing these long-term symptoms in the first place?

The remaining uncertainties can mask the scientific progress of the past few years. Scientists have a better idea of how long Covid works, and why it might cause a wide array of seemingly unconnected symptoms.

But — and this is more important than it might seem — we know what we don’t know. We have a stronger sense of what the most important unanswered questions are and where there is genuine debate among even the experts about this bedeviling condition.

The highly charged public discourse over long Covid can be overwhelming. There is a plethora of research being released at all times, some of it well-vetted, but some of it not. If you or someone you love has long Covid — or you’re worried that you might get it — it can be hard to get even basic answers.

One of the clearest takeaways of the past three years is this: Long Covid does not look the same in every patient.

The federal government has burned through more than $1 billion to study long Covid, an effort to help the millions of Americans who experience brain fog, fatigue, and other symptoms after recovering from a coronavirus infection.

There’s basically nothing to show for it.

The National Institutes of Health hasn’t signed up a single patient to test any potential treatments — despite a clear mandate from Congress to study them. And the few trials it is planning have already drawn a firestorm of criticism, especially one intervention that experts and advocates say may actually make some patients’ long Covid symptoms worse.

Instead, the NIH spent the majority of its money on broader, observational research that won’t directly bring relief to patients. But it still hasn’t published any findings from the patients who joined that study, almost two years after it started.

There’s no sense of urgency to do more or to speed things up, either. The agency isn’t asking Congress for any more funding for long Covid research, and STAT and MuckRock obtained documents showing the NIH refuses to use its own money to change course.

“So far, I don’t think we’ve gotten anything for a billion dollars,” said Ezekiel Emanuel, a physician, vice provost for global initiatives, and co-director of the Healthcare Transformation Institute at the University of Pennsylvania. “That is just unacceptable, and it’s a serious dysfunction.”

Eric Topol, the founder and director of the Scripps Research Translational Institute, said he expected the NIH would have launched many large-scale trials by now, and that testing treatments should have been an urgent priority when Congress first gave the agency money in late 2020.

Tara Ghormley has always been an overachiever. She finished at the top of her class in high school, graduated summa cum laude from college and earned top honors in veterinary school. She went on to complete a rigorous training program and build a successful career as a veterinary internal medicine specialist. But in March 2020 she got infected with the SARS-CoV-2 virus—just the 24th case in the small, coastal central California town she lived in at the time, near the site of an early outbreak in the COVID pandemic. “I could have done without being first at this,” she says.

Almost three years after apparently clearing the virus from her body, Ghormley is still suffering. She gets exhausted quickly, her heartbeat suddenly races, and she goes through periods where she can't concentrate or think clearly. Ghormley and her husband, who have relocated to a Los Angeles suburb, once spent their free time visiting their “happiest place on Earth”—Disneyland—but her health prevented that for more than a year. She still spends most of her days off resting in the dark or going to her many doctors' appointments. Her early infection and ongoing symptoms make her one of the first people in the country with “long COVID,” a condition where symptoms persist for at least three months after the infection and can last for years. The syndrome is known by medical professionals as postacute sequelae of COVID-19, or PASC.

People with long COVID have symptoms such as pain, extreme fatigue and “brain fog,” or difficulty concentrating or remembering things. As of February 2022, the syndrome was estimated to affect about 16 million adults in the U.S. and had forced between two million and four million Americans out of the workforce, many of whom have yet to return. Long COVID often arises in otherwise healthy young people, and it can follow even a mild initial infection. The risk appears at least slightly higher in people who were hospitalized for COVID and in older adults (who end up in the hospital more often). Women and those at socioeconomic disadvantage also face higher risk, as do people who smoke, are obese, or have any of an array of health conditions, particularly autoimmune disease. Vaccination appears to reduce the danger but does not entirely prevent long COVID.