Tagged Chronic Condition (Health)

Weekly Health Quiz: Weight Gain, Covid and Exercise

1 of 7

During pandemic lockdowns, Americans gained, on average, about how many pounds a month?

Half a pound

1 pound

2 pounds

4 pounds

2 of 7

Spread of coronavirus at the gym would likely be highest among people attending this type of group exercise class:

Pilates

Yoga

Strength training

Spin class

3 of 7

Too much high-intensity exercise resulted in signs of damage to these cell structures, the energy generators found in every cell:

Ribosomes

Mitochondria

Lysozymes

Centrioles

4 of 7

Doctors are exploring a possible link between Covid-19 and ringing in the ears, a medical condition known as:

Anosmia

Dysgeusia

Tinnitus

Otitis

5 of 7

True or false? Once you’ve been fully vaccinated against coronavirus, you are fully protected against symptoms of Covid.

True

False

6 of 7

A study of patients in California who suffered from long-haul Covid found that this proportion had no cough, fever or other symptoms in the first 10 days after testing positive for coronavirus:

A tenth

A quarter

A third

Half

7 of 7

This psychiatric condition, formerly known as multiple personality disorder and depicted in films like “Sybil” and “The Three Faces of Eve,” now goes by this name:

Schizoaffective disorder

Borderline personality disorder

Dissociative identity disorder

Post-traumatic stress disorder

Some Long Covid-19 Patients Feel Better After Vaccine Doses

It is too soon to tell whether the shots have a broad beneficial effect on patients with continuing issues, but scientists are intrigued and beginning to study the phenomenon.

Judy Dodd began struggling with long Covid symptoms last spring — shortness of breath, headaches, exhaustion. Then she got the vaccine.

After her first Pfizer-BioNTech shot in late January, she felt so physically miserable that she had to be persuaded to get the second. For three days after that one, she also felt awful. But the fourth day, everything changed.

“I woke up and it was like ‘Oh what a beautiful morning,’” said Ms. Dodd, a middle-school teacher who is also an actor and director. “It was like I’d been directing ‘Sweeney Todd’ for months, and now I’m directing Oklahoma.”

Ms. Dodd, who continues to feel good, is among a number of people who are reporting that the post-Covid symptoms they’ve experienced for months have begun improving, sometimes significantly, after they got the vaccine. It’s a phenomenon that doctors and scientists are watching closely, but as with much about the yearlong coronavirus pandemic, there are many uncertainties.

Scientists are only beginning to study any potential effect of vaccines on long Covid symptoms. Anecdotes run the gamut: Besides those who report feeling better after the shots, many people say they have experienced no change and a small number say they feel worse.

Reports from doctors vary too. Dr. Daniel Griffin, an infectious disease physician at Columbia University, said about 40 percent of the long Covid patients he’s been treating cite symptom improvement after the vaccine. “They notice, ‘Hey, over the days, I’m feeling better. The fatigue isn’t so bad, maybe smell is coming back,’” Dr. Griffin said.

Other doctors say it is too early to know.

“Too few of our participants have been vaccinated so far to really be able to provide insight into this question,” said Dr. Michael Peluso, an infectious disease specialist working on a study of long-term Covid patients at University of California, San Francisco. “I’ve heard anecdotes as well, but I’ve seen too little data so far.”

This month, a small study by British researchers that has not yet been peer reviewed found that eight months after people were hospitalized for Covid-19, those who were vaccinated experienced improvement in more long Covid symptoms than those who weren’t yet vaccinated. The 44 vaccinated patients in the study were older and had more underlying medical conditions, since people with those characteristics qualified for vaccines earlier.

One month after vaccination, those patients reported improvement in 23 percent of their long Covid symptoms like joint pain and breathing, while 5.6 percent of their symptoms had worsened. The 22 unvaccinated people questioned at that time said 15 percent of their symptoms were better, while 14 percent of their symptoms were worse. There was no difference in response between people who received the Pfizer-BioNTech and Oxford-AstraZeneca vaccines.

Additional information comes from two surveys of several hundred people with long Covid symptoms, many of whom were never hospitalized for the disease.

Jim Golen, a former hospice nurse in Saginaw, Minn. He said his long Covid symptoms have gotten worse since his vaccination, but he’s still glad he got the vaccine.
Jim Golen, a former hospice nurse in Saginaw, Minn. He said his long Covid symptoms have gotten worse since his vaccination, but he’s still glad he got the vaccine.Tim Gruber for The New York Times

One survey of 345 people, mostly women and mostly in the U.K., found that two weeks or more after their second vaccine dose, 93 felt slightly better and 18 felt back to normal — a total of 32 percent reporting improved long Covid symptoms.

In that survey, by Gez Medinger, a London-based filmmaker who has experienced post-Covid symptoms, 61 people, just under 18 percent, felt worse, most of them reporting only a slight decline in their condition. Nearly half — 172 people — reported feeling no different.

Another survey, by Survivor Corps, a group of over 150,000 Covid survivors, found that as of March 17, 225 of 577 respondents reported some improvement, while 270 felt no change and 82 felt worse.

Jim Golen, 55, of Saginaw, Minn., feels some long Covid symptoms have worsened since his vaccination. Mr. Golen, a former hospice nurse who also has a small farm, had experienced months of difficulty, including blood clots in his lungs, chest pain, brain fog, insomnia and shortness of breath with any exertion. Late last year, after seeing several doctors, “I was finally starting to get better,” he said.

Since receiving the second dose of the Pfizer vaccine in mid-January, he said, his chest burning and shortness of breath have returned with a vengeance, especially if he taxes himself with activities like collecting sap from the maple trees on his farm. Nonetheless, Mr. Golen said he was “very happy” to be vaccinated, emphasizing that the effects of Covid were worse and preventing it is crucial.

Some people shared stories of stark symptom improvements that took them by surprise.

Laura Gross, 72, of Fort Lee, N.J. rattled off a lengthy list of debilitating long Covid symptoms she’d experienced since April, including exhaustion, joint pain, muscle aches and a “zizzy-dizzy-weaky thing that was like an internal headachy all-over-body vibration.”

Her cognitive fuzziness and forgetfulness were so intense that “brain fog barely describes it,” she said. “It’s more like brain cyclone.”

She also felt uncharacteristically “hopeless, sad, lonely, unmotivated,” she said.

Three days after her first Moderna shot in late January, everything changed. “It was like a revelation,” she said. The brain fog cleared completely, muscle aches were gone, joint pains were less intense and she suddenly had much more energy. It felt, she said, “like the old me.”

That continued after the second dose. “It’s like my cells went kerflooey last year when they met Covid,” she said, and the “vaccine said, ‘Wait, you dopes, that isn’t how you fight this, do it this way.’”

Recently, she walked briskly for 23 minutes and even “ran a little bit because I was so happy,” she said. “I’m a very happy little chappy.”

Laura Gross of Fort Lee, N.J., said brain fog is inadequate in describing her symptoms: “It’s more like brain cyclone,” she said. She reports feeling much better since being vaccinated.Nancy Borowick for The New York Times

Scientists say that understanding whether vaccines help some long Covid patients but not others could help unravel the underlying causes of different symptoms and potential ways to treat them.

“They might be different disease processes and you manage them differently,” said Dr. Adam Lauring, a virologist and infectious disease physician at the University of Michigan. “It might be that there’s a subset of people who have a certain type of long Covid, who respond well to vaccines, but there might be other people who have a different subtype that we haven’t quite defined yet.”

Akiko Iwasaki, an immunologist at Yale, said that a vaccine, by generating antibodies to the coronavirus’s spike protein, could potentially eliminate vestiges of the virus or remnants of viral RNA that may linger in some patients.

If this is occurring, she said, it could suggest that the vaccine “might be like a permanent cure” for those patients.

Dr. Iwasaki said the vaccine might also help people whose long Covid symptoms may be caused by a post-viral response resembling an autoimmune disease if “the vaccine stimulates innate immune responses that dampen these kinds of autoreactive responses,” she said. But based on experiences of people with other autoimmune diseases, that relief would “not be very long-lasting and they would kind of revert back” to having symptoms like fatigue, she said.

Dr. Eric Topol, a professor of molecular medicine at the Scripps Research Institute in San Diego, said he is starting a study to measure physiological information like heart rate, respiratory rate, temperature and markers of immune system response in people with long Covid before they receive a vaccine and weeks afterward.

It’s plausible that “you have your immune system revved up when you’re fighting a reservoir” of virus or RNA remnants, he said, “and that could be an explanation of why you’re in overdrive with your heart rate.” He wants to see if these biological indicators improve post-vaccine.

“We’d really like objective metrics that show that you not just feel better,” Dr. Topol said. “You could feel better from the placebo effect, but it’s unlikely your heart rate’s going to go from 100 to 60 because of a placebo effect. And if we keep seeing that pattern, that would be like Eureka.”

He added, “I think there’s probably something there, but I just don’t know what is the magnitude, how many people are going to benefit.”

There are many other questions: Are there specific characteristics, like age, gender, type or duration of symptoms, that might make some long Covid patients more likely to feel better? Would a vaccine be less effective for people with more complex conditions: people whose symptoms are driven by multiple biological pathways (perhaps both an RNA remnant and autoimmune activation) or whose symptoms have changed or fluctuated over time? Are certain types of vaccines more likely to produce benefit?

“It was awful thinking it may never get better, like ‘Is this my new normal, am I now damaged this way?’” recalled Bridget Hayward of her symptoms, which she says have eased since her vaccination.Alyssa Schukar for The New York Times

Bridget Hayward, 51, an operating room nurse in Alexandria, Va., said that after contracting Covid a year ago, her body ached from her hands to her hips and she became so brain-fogged that instead of asking for a scalpel, she would say “Give me that sharp thing we cut with.”

Almost daily, she would briefly pass out while bending down to fix a patient’s intravenous line or plug in the cord of a hospital bed.

“It was horrifying,” she said. “It was awful thinking it may never get better, like ‘Is this my new normal, am I now damaged this way?’”

After several months, her worst symptoms improved, but she still tired easily, felt hot even in cool weather, and found it too taxing to do some ordinary tasks, she said.

One day after her first dose of the Pfizer vaccine in late December, “it was like click, everything is fine,” she said. Her body temperature has normalized and “it felt like a darkness lifted.”

While “it’s not 100 percent every day,” she said she has so much energy now that “I’m not just getting from A to B, I’m like leaping up.”

One recent day, she did several long-overdue errands. “This may not sound like much but it is a 180-turnaround from three months ago,” she said. “I’m back!”

Kim Leighton, 64, of Vancouver, Wash., has had a similar experience. She was hospitalized last March and had long Covid symptoms that included mini blackouts, shortness of breath, getting lost in her own neighborhood, depression and fatigue.

“It really has been hell,” she said.

When she started feeling better in late January, she didn’t even think to connect it to the vaccine, but later realized her stark improvement had started four days after receiving her first Moderna shot. She is delighted that she can now take walks in downtown Portland and has the desire to reconnect with friends.

“Every day, I feel like I’m feeling stronger,” Ms. Leighton said. “All the stuff I had to let go of, I’m trying to get it back.”

Ms. Dodd, like several others, said she wasn’t taking her improvement for granted. “I’m still sort of wary of what’s around the corner, this disease is so unpredictable,” she said.

But, she added, “even if, God forbid, I have a relapse, to have this time now when I feel better, it’s really amazing.”

Some Long Covid Patients Feel Better After Getting the Vaccine

It is too soon to tell whether the shots have a broad beneficial effect on patients with continuing issues, but scientists are intrigued and beginning to study the phenomenon.

Judy Dodd began struggling with long Covid symptoms last spring — shortness of breath, headaches, exhaustion. Then she got the vaccine.

After her first Pfizer-BioNTech shot in late January, she felt so physically miserable that she had to be persuaded to get the second. For three days after that one, she also felt awful. But the fourth day, everything changed.

“I woke up and it was like ‘Oh what a beautiful morning,’” said Ms. Dodd, a middle-school teacher who is also an actor and director. “It was like I’d been directing ‘Sweeney Todd’ for months, and now I’m directing Oklahoma.”

Ms. Dodd, who continues to feel good, is among a number of people who are reporting that the post-Covid symptoms they’ve experienced for months have begun improving, sometimes significantly, after they got the vaccine. It’s a phenomenon that doctors and scientists are watching closely, but as with much about the yearlong coronavirus pandemic, there are many uncertainties.

Scientists are only beginning to study any potential effect of vaccines on long Covid symptoms. Anecdotes run the gamut: Besides those who report feeling better after the shots, many people say they have experienced no change and a small number say they feel worse.

Reports from doctors vary too. Dr. Daniel Griffin, an infectious disease physician at Columbia University, said about 40 percent of the long Covid patients he’s been treating cite symptom improvement after the vaccine. “They notice, ‘Hey, over the days, I’m feeling better. The fatigue isn’t so bad, maybe smell is coming back,’” Dr. Griffin said.

Other doctors say it is too early to know.

“Too few of our participants have been vaccinated so far to really be able to provide insight into this question,” said Dr. Michael Peluso, an infectious disease specialist working on a study of long-term Covid patients at University of California, San Francisco. “I’ve heard anecdotes as well, but I’ve seen too little data so far.”

This month, a small study by British researchers that has not yet been peer reviewed found that eight months after people were hospitalized for Covid-19, those who were vaccinated experienced improvement in more long Covid symptoms than those who weren’t yet vaccinated. The 44 vaccinated patients in the study were older and had more underlying medical conditions, since people with those characteristics qualified for vaccines earlier.

One month after vaccination, those patients reported improvement in 23 percent of their long Covid symptoms like joint pain and breathing, while 5.6 percent of their symptoms had worsened. The 22 unvaccinated people questioned at that time said 15 percent of their symptoms were better, while 14 percent of their symptoms were worse. There was no difference in response between people who received the Pfizer-BioNTech and Oxford-AstraZeneca vaccines.

Additional information comes from two surveys of several hundred people with long Covid symptoms, many of whom were never hospitalized for the disease.

Jim Golen, a former hospice nurse in Saginaw, Minn. He said his long Covid symptoms have gotten worse since his vaccination, but he’s still glad he got the vaccine.
Jim Golen, a former hospice nurse in Saginaw, Minn. He said his long Covid symptoms have gotten worse since his vaccination, but he’s still glad he got the vaccine.Tim Gruber for The New York Times

One survey of 345 people, mostly women and mostly in the U.K., found that two weeks or more after their second vaccine dose, 93 felt slightly better and 18 felt back to normal — a total of 32 percent reporting improved long Covid symptoms.

In that survey, by Gez Medinger, a London-based filmmaker who has experienced post-Covid symptoms, 61 people, just under 18 percent, felt worse, most of them reporting only a slight decline in their condition. Nearly half — 172 people — reported feeling no different.

Another survey, by Survivor Corps, a group of over 150,000 Covid survivors, found that as of March 16, 207 of 508 respondents reported some improvement, while 231 felt no change and 70 felt worse.

Jim Golen, 55, of Saginaw, Minn., feels some long Covid symptoms have worsened since his vaccination. Mr. Golen, a former hospice nurse who also has a small farm, had experienced months of difficulty, including blood clots in his lungs, chest pain, brain fog, insomnia and shortness of breath with any exertion. Late last year, after seeing several doctors, “I was finally starting to get better,” he said.

Since receiving the second dose of the Pfizer vaccine in mid-January, he said, his chest burning and shortness of breath have returned with a vengeance, especially if he taxes himself with activities like collecting sap from the maple trees on his farm. Nonetheless, Mr. Golen said he was “very happy” to be vaccinated, emphasizing that the effects of Covid were worse and preventing it is crucial.

Some people shared stories of stark symptom improvements that took them by surprise.

Laura Gross, 72, of Fort Lee, N.J. rattled off a lengthy list of debilitating long Covid symptoms she’d experienced since April, including exhaustion, joint pain, muscle aches and a “zizzy-dizzy-weaky thing that was like an internal headachy all-over-body vibration.”

Her cognitive fuzziness and forgetfulness were so intense that “brain fog barely describes it,” she said. “It’s more like brain cyclone.”

She also felt uncharacteristically “hopeless, sad, lonely, unmotivated,” she said.

Three days after her first Moderna shot in late January, everything changed. “It was like a revelation,” she said. The brain fog cleared completely, muscle aches were gone, joint pains were less intense and she suddenly had much more energy. It felt, she said, “like the old me.”

That continued after the second dose. “It’s like my cells went kerflooey last year when they met Covid,” she said, and the “vaccine said, ‘Wait, you dopes, that isn’t how you fight this, do it this way.’”

Recently, she walked briskly for 23 minutes and even “ran a little bit because I was so happy,” she said. “I’m a very happy little chappy.”

Laura Gross of Fort Lee, N.J., said brain fog is inadequate in describing her symptoms: “It’s more like brain cyclone,” she said. She reports feeling much better since being vaccinated.Nancy Borowick for The New York Times

Scientists say that understanding whether vaccines help some long Covid patients but not others could help unravel the underlying causes of different symptoms and potential ways to treat them.

“They might be different disease processes and you manage them differently,” said Dr. Adam Lauring, a virologist and infectious disease physician at the University of Michigan. “It might be that there’s a subset of people who have a certain type of long Covid, who respond well to vaccines, but there might be other people who have a different subtype that we haven’t quite defined yet.”

Akiko Iwasaki, an immunologist at Yale, said that a vaccine, by generating antibodies to the coronavirus’s spike protein, could potentially eliminate vestiges of the virus or remnants of viral RNA that may linger in some patients.

If this is occurring, she said, it could suggest that the vaccine “might be like a permanent cure” for those patients.

Dr. Iwasaki said the vaccine might also help people whose long Covid symptoms may be caused by a post-viral response resembling an autoimmune disease if “the vaccine stimulates innate immune responses that dampen these kinds of autoreactive responses,” she said. But based on experiences of people with other autoimmune diseases, that relief would “not be very long-lasting and they would kind of revert back” to having symptoms like fatigue, she said.

Dr. Eric Topol, a professor of molecular medicine at the Scripps Research Institute in San Diego, said he is starting a study to measure physiological information like heart rate, respiratory rate, temperature and markers of immune system response in people with long Covid before they receive a vaccine and weeks afterward.

It’s plausible that “you have your immune system revved up when you’re fighting a reservoir” of virus or RNA remnants, he said, “and that could be an explanation of why you’re in overdrive with your heart rate.” He wants to see if these biological indicators improve post-vaccine.

“We’d really like objective metrics that show that you not just feel better,” Dr. Topol said. “You could feel better from the placebo effect, but it’s unlikely your heart rate’s going to go from 100 to 60 because of a placebo effect. And if we keep seeing that pattern, that would be like Eureka.”

He added, “I think there’s probably something there, but I just don’t know what is the magnitude, how many people are going to benefit.”

There are many other questions: Are there specific characteristics, like age, gender, type or duration of symptoms, that might make some long Covid patients more likely to feel better? Would a vaccine be less effective for people with more complex conditions: people whose symptoms are driven by multiple biological pathways (perhaps both an RNA remnant and autoimmune activation) or whose symptoms have changed or fluctuated over time? Are certain types of vaccines more likely to produce benefit?

“It was awful thinking it may never get better, like ‘Is this my new normal, am I now damaged this way?’” recalled Bridget Hayward of her symptoms, which she says have eased since her vaccination.Alyssa Schukar for The New York Times

Bridget Hayward, 51, an operating room nurse in Alexandria, Va., said that after contracting Covid a year ago, her body ached from her hands to her hips and she became so brain-fogged that instead of asking for a scalpel, she would say “Give me that sharp thing we cut with.”

Almost daily, she would briefly pass out while bending down to fix a patient’s intravenous line or plug in the cord of a hospital bed.

“It was horrifying,” she said. “It was awful thinking it may never get better, like ‘Is this my new normal, am I now damaged this way?’”

After several months, her worst symptoms improved, but she still tired easily, felt hot even in cool weather, and found it too taxing to do some ordinary tasks, she said.

One day after her first dose of the Pfizer vaccine in late December, “it was like click, everything is fine,” she said. Her body temperature has normalized and “it felt like a darkness lifted.”

While “it’s not 100 percent every day,” she said she has so much energy now that “I’m not just getting from A to B, I’m like leaping up.”

One recent day, she did several long-overdue errands. “This may not sound like much but it is a 180-turnaround from three months ago,” she said. “I’m back!”

Kim Leighton, 64, of Vancouver, Wash., has had a similar experience. She was hospitalized last March and had long Covid symptoms that included mini blackouts, shortness of breath, getting lost in her own neighborhood, depression and fatigue.

“It really has been hell,” she said.

When she started feeling better in late January, she didn’t even think to connect it to the vaccine, but later realized her stark improvement had started four days after receiving her first Moderna shot. She is delighted that she can now take walks in downtown Portland and has the desire to reconnect with friends.

“Every day, I feel like I’m feeling stronger,” Ms. Leighton said. “All the stuff I had to let go of, I’m trying to get it back.”

Ms. Dodd, like several others, said she wasn’t taking her improvement for granted. “I’m still sort of wary of what’s around the corner, this disease is so unpredictable,” she said.

But, she added, “even if, God forbid, I have a relapse, to have this time now when I feel better, it’s really amazing.”

Some Covid Survivors Haunted by Loss of Smell and Taste

Some Covid Survivors Haunted by Loss of Smell and Taste

As the coronavirus claims more victims, a once-rare diagnosis is receiving new attention from scientists, who fear it may affect nutrition and mental health.

Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.
Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.Credit…Jovelle Tamayo for The New York Times
Roni Caryn Rabin

  • Jan. 2, 2021, 10:26 a.m. ET

Until March, when everything started tasting like cardboard, Katherine Hansen had such a keen sense of smell that she could recreate almost any restaurant dish at home without the recipe, just by recalling the scents and flavors.

Then the coronavirus arrived. One of Ms. Hansen’s first symptoms was a loss of smell, and then of taste. Ms. Hansen still cannot taste food, and says she can’t even tolerate chewing it. Now she lives mostly on soups and shakes.

“I’m like someone who loses their eyesight as an adult,” said Ms. Hansen, a realtor who lives outside Seattle. “They know what something should look like. I know what it should taste like, but I can’t get there.”

A diminished sense of smell, called anosmia, has emerged as one of the telltale symptoms of Covid-19, the illness caused by the coronavirus. It is the first symptom for some patients, and sometimes the only one. Often accompanied by an inability to taste, anosmia occurs abruptly and dramatically in these patients, almost as if a switch had been flipped.

Most regain their senses of smell and taste after they recover, usually within weeks. But in a minority of patients like Ms. Hansen, the loss persists, and doctors cannot say when or if the senses will return.

Scientists know little about how the virus causes persistent anosmia or how to cure it. But cases are piling up as the coronavirus sweeps across the world, and some experts fear that the pandemic may leave huge numbers of people with a permanent loss of smell and taste. The prospect has set off an urgent scramble among researchers to learn more about why patients are losing these essential senses, and how to help them.

“Many people have been doing olfactory research for decades and getting little attention,” said Dr. Dolores Malaspina, professor of psychiatry, neuroscience, genetics and genomics at Icahn School of Medicine at Mount Sinai in New York. “Covid is just turning that field upside down.”

Smell is intimately tied to both taste and appetite, and anosmia often robs people of the pleasure of eating. But the sudden absence also may have a profound impact on mood and quality of life.

Studies have linked anosmia to social isolation and anhedonia, an inability to feel pleasure, as well as a strange sense of detachment and isolation. Memories and emotions are intricately tied to smell, and the olfactory system plays an important though largely unrecognized role in emotional well-being, said Dr. Sandeep Robert Datta, an associate professor of neurobiology at Harvard Medical School.

“You think of it as an aesthetic bonus sense,” Dr. Datta said. “But when someone is denied their sense of smell, it changes the way they perceive the environment and their place in the environment. People’s sense of well-being declines. It can be really jarring and disconcerting.”

Many sufferers describe the loss as extremely upsetting, even debilitating, all the more so because it is invisible to others.

“Smell is not something we pay a lot of attention to until it’s gone,” said Pamela Dalton, who studies smell’s link to cognition and emotion at the Monell Chemical Senses Center in Philadelphia. “Then people notice it, and it is pretty distressing. Nothing is quite the same.”

British scientists studied the experiences of 9,000 Covid-19 patients who joined a Facebook support group set up by the charity group AbScent between March 24 and September 30. Many members said they had not only lost pleasure in eating, but also in socializing. The loss had weakened their bonds with other people, affecting intimate relationships and leaving them feeling isolated, even detached from reality.

“I feel alien from myself,” one participant wrote. “It’s also kind of a loneliness in the world. Like a part of me is missing, as I can no longer smell and experience the emotions of everyday basic living.”

Another said, “I feel discombobulated — like I don’t exist. I can’t smell my house and feel at home. I can’t smell fresh air or grass when I go out. I can’t smell the rain.”

Loss of smell is a risk factor for anxiety and depression, so the implications of widespread anosmia deeply trouble mental health experts. Dr. Malaspina and other researchers have found that olfactory dysfunction often precedes social deficits in schizophrenia, and social withdrawal even in healthy individuals.

“From a public health perspective, this is really important,” Dr. Datta said. “If you think worldwide about the number of people with Covid, even if only 10 percent have a more prolonged smell loss, we’re talking about potentially millions of people.”

The most immediate effects may be nutritional. People with anosmia may continue to perceive basic tastes — salty, sour, sweet, bitter and umami. But taste buds are relatively crude preceptors. Smell adds complexity to the perception of flavor via hundreds of odor receptors signaling the brain.

Many people who can’t smell will lose their appetites, putting them at risk of nutritional deficits and unintended weight loss. Kara VanGuilder, who lives in Brookline, Mass., said she has lost 20 pounds since March, when her sense of smell vanished.

“I call it the Covid diet,” said Ms. VanGuilder, 26, who works in medical administration. “There no point in indulging in brownies if I can’t really taste the brownie.”

But while she jokes about it, she added, the loss has been distressing: “For a few months, every day almost, I would cry at the end of the day.”

Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.
Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.Credit…Joshua Bright for The New York Times

Smells also serve as a primal alarm system alerting humans to dangers in our environment, like fires or gas leaks. A diminished sense of smell in old age is one reason older individuals are more prone to accidents, like fires caused by leaving burning food on the stove.

Michele Miller, of Bayside, N.Y., was infected with the coronavirus in March and hasn’t smelled anything since then. Recently, her husband and daughter rushed her out of their house, saying the kitchen was filling with gas.

She had no idea. “It’s one thing not to smell and taste, but this is survival,” Ms. Miller said.

Humans constantly scan their environments for smells that signal changes and potential harms, though the process is not always conscious, said Dr. Dalton, of the Monell Chemical Senses Center.

Smell alerts the brain to the mundane, like dirty clothes, and the risky, like spoiled food. Without this form of detection, “people get anxious about things,” Dr. Dalton said.

Even worse, some Covid-19 survivors are tormented by phantom odors that are unpleasant and often noxious, like the smells of burning plastic, ammonia or feces, a distortion called parosmia.

Eric Reynolds, a 51-year-old probation officer in Santa Maria, Calif., lost his sense of smell when he contracted Covid-19 in April. Now, he said, he often perceives foul odors that he knows don’t exist. Diet drinks taste like dirt; soap and laundry detergent smell like stagnant water or ammonia.

“I can’t do dishes, it makes me gag,” Mr. Reynolds said. He’s also haunted by phantom smells of corn chips and a scent he calls “old lady perfume smell.”

It’s not unusual for patients like him to develop food aversions related to their distorted perceptions, said Dr. Evan R. Reiter, medical director of the smell and taste center at Virginia Commonwealth University, who has been tracking the recovery of some 2,000 Covid-19 patients who lost their sense of smell.

One of his patients is recovering, but “now that it’s coming back, she’s saying that everything or virtually everything that she eats will give her a gasoline taste or smell,” Dr. Reiter said.

The derangement of smell may be part of the recovery process, as receptors in the nose struggle to reawaken, sending signals to the brain that misfire or are misread, Dr. Reiter said.

After loss of smell, “different populations or subtypes of receptors may be impacted to different degrees, so the signals your brain is used to getting when you eat steak will be distorted and may trick your brain into thinking you’re eating dog poop or something else that’s not palatable.”

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Patients desperate for answers and treatment have tried therapies like smell training: sniffing essential oils or sachets with a variety of odors — such as lavender, eucalyptus, cinnamon and chocolate — several times a day in an effort to coax back the sense of smell. A recent study of 153 patients in Germany found the training could be moderately helpful in those who had lower olfactory functioning and in those with parosmia.

Dr. Alfred Iloreta, an otolaryngologist at Mount Sinai Hospital in New York, has begun a clinical trial to see whether taking fish oil helps restore the sense of smell. The omega-3 fatty acids found in fish oil may protect nerve cells from further damage or help regenerate nerve growth, he suggested.

“If you have no smell or taste, you have a hard time eating anything, and that’s a massive quality of life issue,” Dr. Iloreta said. “My patients, and the people I know who have lost their smell, are completely wrecked by it.”

Mr. Reynolds feels the loss most acutely when he goes to the beach near his home to walk. He no longer smells the ocean or salt air.

“My mind knows what it smells like,” he said. “And when I get there, it’s not there.”

He Was Hospitalized for Covid-19. Then Hospitalized Again. And Again.

Credit…Emily Rose Bennett for The New York Times

He Was Hospitalized for Covid-19. Then Hospitalized Again. And Again.

Significant numbers of coronavirus patients experience long-term symptoms that send them back to the hospital, taxing an already overburdened health system.

Credit…Emily Rose Bennett for The New York Times

Pam Belluck

  • Dec. 30, 2020, 3:00 a.m. ET

The routine things in Chris Long’s life used to include biking 30 miles three times a week and taking courses toward a Ph.D. in eight-week sessions.

But since getting sick with the coronavirus in March, Mr. Long, 54, has fallen into a distressing new cycle — one that so far has landed him in the hospital seven times.

Periodically since his initial five-day hospitalization, his lungs begin filling again; he starts coughing uncontrollably and runs a low fever. Roughly 18 days later, he spews up greenish-yellow fluid, signaling yet another bout of pneumonia.

Soon, his oxygen levels drop and his heart rate accelerates to compensate, sending him to a hospital near his home in Clarkston, Mich., for several days, sometimes in intensive care.

“This will never go away,” he said, describing his worst fear. “This will be my going-forward for the foreseeable future.”

Nearly a year into the pandemic, it’s clear that recovering from Covid-19’s initial onslaught can be an arduous, uneven journey. Now, studies reveal that a significant subset of patients are having to return to hospitals, sometimes repeatedly, with complications triggered by the disease or by the body’s efforts to defeat the virus.

Even as vaccines give hope for stopping the spread of the virus, the surge of new cases portends repeated hospitalizations for more patients, taxing medical resources and turning some people’s path to recovery into a Sisyphean odyssey that upends their lives.

“It’s an urgent medical and public health question,” said Dr. Girish Nadkarni, an assistant professor of medicine at Mount Sinai Hospital in New York, who, with another assistant professor, Dr. Anuradha Lala, is studying readmissions of Covid-19 patients.

Data on rehospitalizations of coronavirus patients are incomplete, but early studies suggest that in the United States alone, tens of thousands or even hundreds of thousands could ultimately return to the hospital.

A study by the Centers for Disease Control and Prevention of 106,543 coronavirus patients initially hospitalized between March and July found that one in 11 was readmitted within two months of being discharged, with 1.6 percent of patients readmitted more than once.

In another study of 1,775 coronavirus patients discharged from 132 V.A. hospitals in the pandemic’s early months, nearly a fifth were rehospitalized within 60 days. More than 22 percent of them needed intensive care, and 7 percent required ventilators.

And in a report on 1,250 patients discharged from 38 Michigan hospitals from mid-March to July, 15 percent were rehospitalized within 60 days.

Recurring admissions don’t just involve patients who were severely ill the first time around.

“Even if they had a very mild course, at least one-third have significant symptomology two to three months out,” said Dr. Eleftherios Mylonakis, chief of infectious diseases at Brown University’s Warren Alpert Medical School and Lifespan hospitals, who co-wrote another report. “There is a wave of readmissions that is building, because at some point these people will say ‘I’m not well.’”

Many who are rehospitalized were vulnerable to serious symptoms because they were over 65 or had chronic conditions. But some younger and previously healthy people have returned to hospitals, too.

When Becca Meyer, 31, of Paw Paw, Mich., contracted the coronavirus in early March, she initially stayed home, nursing symptoms such as difficulty breathing, chest pain, fever, extreme fatigue and hallucinations that included visions of being attacked by a sponge in the shower.

Ms. Meyer, a mother of four, eventually was hospitalized for a week in March and again in April. She was readmitted for an infection in August and for severe nausea in September, according to medical records, which labeled her condition “long haul Covid-19.”

Because she couldn’t hold down food, doctors discharged her with a nasal feeding tube connected to protein-and-electrolyte formula on a pole, which, she said, “I’m supposed to be attached to 20 hours a day.”

Feeding tube issues required hospitalization for nearly three weeks in October and a week in December. She has been unable to resume her job in customer service, spent the summer using a walker, and has had a home health nurse for weeks.

“It’s been a roller coaster since March and I’m now in the downswing of it, where I’m back to being in bed all the time and not being able to eat much, coughing a lot more, having more chest pain,” she said.

Readmissions strain hospital resources, and returning patients may be exposed to new infections or develop muscle atrophy from being bedridden. Mr. Long and Ms. Meyer said they contracted the bacterial infection C. difficile during rehospitalizations.

“Readmissions have been associated, even before Covid, with worse patient outcomes,” Dr. Mylonakis said.

Some research suggests implications for hospitals currently overwhelmed with cases. A Mount Sinai Hospital study of New York’s first wave found that patients with shorter initial stays and those not sick enough for intensive care were more likely to return within two weeks.

Dr. Lala, who co-wrote the study, said the thinking at overstretched hospitals was “we have a lack of resources, so if the patients are stable get them home.” But, she added, “the fact that length of stay was indeed shorter for those patients who return is begging the question of: Were we kicking these people out the door too soon?”

Many rehospitalized patients have respiratory problems, but some have blood clots, heart trouble, sepsis, gastrointestinal symptoms or other issues, doctors report. Some have neurological symptoms like brain fog, “a clear cognitive issue that is evident when they get readmitted,” said Dr. Vineet Chopra, chief of hospital medicine at the University of Michigan, who co-wrote the Michigan study. “It is there, and it is real.”

Dr. Laurie Jacobs, chairwoman of internal medicine at Hackensack University Medical Center, said causes of readmissions vary.

“Sometimes there’s a lot of push to get patients out of the hospital, and they want to get out of the hospital and sometimes they’re not ready,” so they return, she said. But some appropriately discharged patients develop additional problems or return to hospitals because they lack affordable outpatient care.

Antibiotics and other medications belonging to Mr. Long.
Antibiotics and other medications belonging to Mr. Long.Credit…Emily Rose Bennett for The New York Times

Mr. Long’s ordeal began on March 9. “I couldn’t stand up without falling over,” he said.

His primary physician, Dr. Benjamin Diaczok, immediately told him to call an ambulance.

“I crawled out to the front door,” recalled Mr. Long. He was barefoot and remembers sticking out his arm to prop open the door for the ambulance crew, who found him facedown.

He awoke three days later, in the hospital, when he accidentally pulled out the tubes to the ventilator he’d been hooked up to. After two more days, he’d stabilized enough to return to the apartment where he lives alone, an hour north of Detroit.

Mr. Long had some previous health issues, including blood clots in his lungs and legs several years ago and an irregular heartbeat requiring an implanted heart monitor in 2018. Still, before Covid-19, he was “very high-functioning, very energetic,” Dr. Diaczok said.

Now, Mr. Long said: “I’ve got scarred lungs, pulmonary fibrosis, and I’m running right around 75-to-80 percent lung capacity.”

He was rehospitalized in April, May, June, July, August and September, requiring oxygen and intravenous antibiotics, potassium and magnesium.

“Something must have happened to his lungs that is making them more prone for this,” Dr. Diaczok said.

Mr. Long, a former consultant on tank systems for the military, is also experiencing brain fog that’s forced a hiatus from classes toward a Ph.D. in business convergence strategy.

“I read 10 pages in one of my textbooks and then five minutes later, after a phone call, I can’t remember what I read,” he said.

“It’s horrible, ”Dr. Diaczok said. “This is a man that thinks for a living, and he can’t do his job.”

And his heart arrhythmia, controlled since 2018, has resurfaced. Unless Mr. Long, who is 6-foot-7, sleeps at an incline on his couch, his heart skips beats, causing his monitor to prompt middle-of-the-night calls from his doctor’s office. Unable to lie in bed, “I don’t sleep through the night.”

Small exertions — “just to stand up to go do the dishes” — are exhausting. In July, he tried starting physical therapy but was told he wasn’t ready.

In August, he got up too fast, fell and “I was very confused,” he recalled. During that hospital readmission, doctors noted “altered mental status” from dehydration and treated him for pneumonia and functional lung collapse.

In late October, Mr. Long developed pneumonia again, but under Dr. Diaczok’s guidance, managed at home with high-dose oral antibiotics.

In December, when a pulmonologist administered a breathing test, “I couldn’t make it six seconds,” he said.

Mr. Long repeatedly measures his temperature and pulse oxygen, and can feel in his chest when “trouble’s coming,” he said. Determined to recover, he tries to walk short distances. “Can I make it to take out the trash?” he’ll ask himself. On a good day, he’ll walk eight feet to his mailbox.

“I’m going to be around to walk my daughters down the aisle and see my grandkids,” said Mr. Long, voice cracking. “I’m not going to let this thing win.”

Covid Guide: How to Get Through the Pandemic

Dec. 18, 2020

Hang in there, help is on the way

Times are tough now, but the end is in sight. If we hunker down, keep our families safe during the holidays and monitor our health at home, life will get better in the spring. Here’s how to get through it.

Tara Parker-Pope

Illustrations by Vinnie Neuberg

Everyone is tired of living like this. We miss our families and our friends. We miss having fun. We miss kissing our partners goodbye in the morning and packing school lunches. We miss travel and bars and office gossip and movie theaters and sporting events.

We miss normal life.

It has been a long, difficult year, and there are many tough weeks still ahead. The coronavirus is raging, and the United States is facing a grim winter, on track for 450,000 deaths from Covid-19 by February, maybe more.

But if we can safely soldier through these next few months, then normal life — or at least a new version of normal — will be within reach. New vaccines that are highly protective against coronavirus are being rolled out right now, first to health care workers and the most vulnerable groups, and then to the general population this spring.

“Help is on the way,” says Dr. Anthony S. Fauci, the nation’s top infectious disease expert. “A vaccine is literally on the threshold of being implemented. To me that is more of an incentive to not give up, but to double down and say, ‘We’re going to get through this.’”

The vaccine won’t change life overnight. It will take months to get enough people vaccinated so that the virus has nowhere to go. But the more everyone does their part to slow down the virus now — by wearing a mask and restricting social contacts — the better and faster the vaccine will work to slow the pandemic once we can all start getting vaccinated this spring.

“Why would you want to be one of the people who is the last person to get infected?” says Dr. Fauci. “It’s almost like being the last person to get killed in a war. You want to hang in there and protect yourself, because the end is in sight.”

(1)

Hunker Down for a Little Bit Longer

The pandemic is surging, but as bad as things are, the end is in sight. By doubling down on precautions, we can slow the virus and save lives.

A crucial number to watch this winter is the test positivity rate for your state and community. The number represents the percentage of coronavirus tests that are positive compared to the overall number of tests being given, and it’s an important indicator of your risk of coming down with Covid-19. When positive test rates in a community stay at 5 percent or lower for two weeks, you’re less likely to cross paths with an infected person. Since the fall, the national test positivity rate has crept above 10 percent, and it’s been 30 percent or higher in several states.

Rising case counts and rising test positivity rates mean there is more virus out there — and you need to double down on precautions, especially if you have a high-risk person in your orbit. Cut back on trips to the store or start having groceries delivered. Scale back your holiday plans. Don’t invite friends indoors, even for a few minutes. Always keep six feet of distance from people who don’t live in your home. Skip haircuts and manicures until the numbers come down again. Wear a mask.

Close your leaky bubble.

Here’s the harsh reality of virus transmission: If someone in your family gets sick, the infection probably came from you, another family member or someone you know. The main way coronavirus is transmitted is through close contact with an infected person in an enclosed space.

“One of the challenges we have is that familiarity is seen as being a virus protector,” said Michael Osterholm, a member of President-elect Joseph R. Biden Jr.’s coronavirus advisory group and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “More likely than not, knowing someone is the risk factor for getting infected.”

This summer, 47 percent of Americans said they had formed a “pod” or social “bubble” that includes two or more households committed to strict precautions so the group can safely socialize indoors.But sometimes your bubble is leakier than you realize. Farhad Manjoo, an opinion columnist for The Times, had initially assumed his bubble was pretty small, but it turned out that he was having direct or indirect contact with more than 100 people.

Whether your bubble is just your immediate household — or you’ve formed a bubble with others — take some time to check in with everyone and seal the leaks. This requires everyone to be honest about the precautions they’re taking (or not taking). Dr. Osterholm said that convincing people that their friends might infect them has been one of the biggest challenges of the pandemic. He told the story of a man and a woman who both contracted Covid-19 after attending a wedding.

“He told me, ‘We didn’t fly. I knew everybody there,’” said Dr. Osterholm. “He somehow had the mistaken belief that by knowing the person, you won’t get infected from them. We’ve got to break through that concept.”

Mask up. You’re going to need it for a while.

A study by the Institute for Health Metrics and Evaluation at the University of Washington estimated that 130,000 lives could be saved by February if mask use became universal in the United States immediately.

Various studies have used machines puffing fine mists to show that high-quality masks can significantly reduce the spread of pathogens between people in conversation. And the common-sense evidence that masks work has become overwhelming. One well-known C.D.C. study showed that, even in a Springfield, Mo., hair salon where two stylists were infected, not one of the 139 customers whose hair they cut over the course of 10 days caught the disease. A city health order had required that both the stylists and the customers be masked.

Choose a mask with two or three layers that fits well and covers your face from the bridge of your nose to under your chin. “Something is better than nothing,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists. “Even the simplest cloth mask of one layer of material blocks half or more of aerosols we think are important to transmission.”

Watch the clock, and take the fun outside.

When making decisions about how you’re spending your time this winter, watch the clock. If you’re spending time indoors with people who don’t live with you, wear a mask and keep the visit as short as possible. (Better yet, don’t do it at all.) Layer up, get hand warmers, some blankets, an outdoor heater — and move social events outdoors.

In an enclosed space, like an office, at a birthday party, in a restaurant or in a church, you can still become infected from a person across the room if you share the same air for an extended period of time. There’s no proven time limit that is safest, but based on contact tracing guidelines and the average rate at which we expel viral particles — through breathing, speaking, singing and coughing — it’s best to wear a mask and keep indoor activities, like shopping or haircuts, to about 30 minutes.

Take care of yourself, save a medical worker.

The country’s doctors, nurses and other health care workers are at a breaking point. Long gone are the raucous nightly cheers, loud applause and clanging that bounced off buildings and hospital windows in the United States and abroad — the sounds of public appreciation each night at 7 for those on the pandemic’s front line.

“Nobody’s clapping anymore,” said Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis. “They’re over it.”

In interviews, more than two dozen frontline medical workers described the unrelenting stress that has become an endemic part of the health care crisis nationwide. Jina Saltzman, a physician assistant in Chicago, said she was growing increasingly disillusioned with the nation’s lax approach to penning in the virus. In mid-November, she was astounded to see crowds of unmasked people in a restaurant as she picked up a pizza. “It’s so disheartening. We’re coming here to work every day to keep the public safe,” she said. “But the public isn’t trying to keep the public safe.”

(2)

Scale Back Your Holiday Plans

How and when the pandemic ends will depend on the choices we make this winter, particularly around Christmas and New Year’s Eve.

Nobody wants to open presents by Zoom, light holiday candles at home alone or clink virtual champagne glasses to ring in the New Year.

But here we are, in the midst of a surging pandemic, on course to losing nearly a half million souls in less than a year. Despite the promise of a vaccine on the horizon, only a tiny fraction of Americans will be vaccinated by the end of December. Vaccines won’t enter large-scale distribution until spring 2021.

The only way to drive down infection rates for now will be to avoid large indoor gatherings, wear masks, cancel travel and limit your holiday celebrations to just those who live in your home.

Dr. Fauci said he, his wife and three daughters, who live in different parts of the country, all made a family decision not to travel for the holidays. It will be the first Christmas in 30 years that the entire family won’t be together.

“I’m a person in an age group that’s at high risk of serious consequences,” said Dr. Fauci. “That’s the first Thanksgiving since any of my three daughters were born that we have not spent it as a family. That was painful, but it was something that needed to be done. We are going to do the same thing over Christmas for the simple reason that I don’t see anything changing between Thanksgiving and Christmas and Hanukkah. In fact, I see it getting worse.”

If you do travel, get tested.

People who choose to travel over the holiday season despite the warnings should consider taking precautions. First, try to quarantine for at least a week (two weeks if possible) before your trip or visit with another household. The C.D.C. now recommends that domestic air travelers get tested before and after their trip.

Remember, a lot can go wrong between the time you take a test and the moment you hug Grandma. Not only are false negatives possible, you need to consider the risk of catching the virus after taking the test — in an airport, in a plane or from a taxi driver or rental car agent.

For a laboratory test, check the turnaround time in your area and try to schedule it as close as possible to your visit. If you’re using rapid testing, try to take more than one test over the days leading up to your visit, and if possible, get a rapid test on the same day you plan to visit family, friends or a vulnerable person. Test again after you arrive if you can.

Plan a safer holiday gathering.

If you’re determined to have people to your home for the holidays, keep the guest list small and consider these precautions.

Get tested: If testing is available in your area, consider asking all guests to be tested a few days before the holiday, timing it so they get the results before coming to your home. If rapid testing is available, get tested a few times during the week and on the day of the social event.

Move the event outside: Even if it’s cold outside, try hosting all or part of your holiday celebration outdoors. Look into space heaters and fire pits to warm a porch or patio. Even a partially open space, like a screened-in porch or a garage with the door open, is better than socializing indoors. If you decide to stay indoors, open the windows and turn on exhaust fans to help ventilate your home.

Wear masks: All guests should wear a mask when not eating. If you’re the host, set the example and put your mask on after the meal is over and everyone is enjoying the conversation. Limit the amount of time you spend together indoors.

Socialize outdoors the Scandinavian way.

In the pandemic, rather than feeling depressed that the arrival of cold weather will mean that you’ll be isolated indoors, apart from friends and family, we can take lessons from Scandinavians about how to continue getting together outdoors.

(3)

Take Care of Yourself at Home

Covid-19 can be scary, but we’ve learned a lot about how to monitor the illness and home — and when to seek hospital care.

Since the start of the pandemic, we’ve learned a lot about how to care for people infected with Covid-19. Death rates from the disease are dropping as doctors have gotten better at treating it and advising patients when to seek medical care.

Steroids like dexamethasone have lowered the number of deaths among hospitalized patients by about one-third. And although limited in supply, monoclonal antibodies, a treatment given to President Trump when he was ill with coronavirus, can possibly shorten hospital stays when given early in the course of infection.

But the vast majority of patients with Covid-19 will manage the illness at home. Check in with your doctor early in the course of your illness, and make a plan for monitoring your health and checking in again if you start to feel worse.

Get tested if you have symptoms.

Ideally, you should be able to get a coronavirus test whenever you want it. But in the United States, test availability varies around the country, depending on whether supplies are low or labs are overwhelmed. Check with your doctor, an urgent care clinic or your local health department about where to get tested in your area.

If you feel sick, you should be tested for Covid-19. A dry cough, fatigue, headache, fever or loss of sense of smell are some of the common symptoms of Covid-19. After you take your test, stay isolated from others and alert the people you’ve spent time with over the last few days, so they can take precautions while you’re waiting for your result. Many tests will work best if you are in the first week of your symptoms.

Track your symptoms.

Marking your calendar at the first sign of illness, and tracking your symptoms and oxygen levels, are important steps in monitoring a coronavirus infection. Covid-19 has been unpredictable in the range of symptoms it can cause. But when it turns serious, it often follows a consistent pattern.

While every patient is different, doctors say that days five through 10 of the illness are often the most worrisome time for respiratory complications of Covid-19. Covid-19 is a miserable illness, and it’s not always easy to know when to go to the emergency room. It’s important during this time to stay in touch with your doctor. Telemedicine makes it possible to consult with your doctor without exposing others to your illness.

Get a fingertip pulse oximeter.

The best way to monitor your health during Covid-19 is to use a pulse oximeter, a small device that clips onto your finger and measures your blood oxygen levels. If it drops to 93 or lower, it could be a sign that your oxygen levels are dropping. Call your doctor or go to the emergency room.

Pro tip: One of the things to remember about reading a pulse oximeter is that many of them are designed to be read by someone facing you, not the person wearing it. If you’re looking at it upside down, a healthy reading of 98 could look like an alarming 86.

Caring for someone with Covid-19

Caring for someone with mild to moderate symptoms of the coronavirus is similar to caring for someone with the flu. Give them supportive care, fluids, soups and Tylenol, and have them take their temperature and monitor oxygen levels with a pulse oximeter regularly. Always wear a mask in the sick person’s room even if they are not there or have recovered. Coronavirus particles can last as long as three days on various surfaces, and can be shaken loose when you pick up clothes, change bedding or pick up soiled tissues.

The plight of “Covid long-haulers”

It’s unclear how many people develop lingering and sometimes debilitating symptoms after a bout of Covid-19. Such symptoms — ranging from breathing trouble to heart issues to cognitive and psychological problems — are already plaguing an untold number of people worldwide. Even for people who were never sick enough to be hospitalized, the aftermath can be long and grueling, with a complex and lasting mix of symptoms.

There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials say, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

(4)

Look for Better Days This Spring

With the rollout of the vaccine, an end to the pandemic is in sight. Life will start to feel more normal in mid- to late 2021, depending on how many people get vaccinated.

Earlier this month, The Times spoke with Dr. Fauci about his predictions for the spring. Here’s what he had to say.

The end game for viral disease outbreaks, particularly respiratory diseases, is a vaccine. We can do public health measures that are tempering things, waiting for the ultimate showstopper, which is a vaccine. That’s why I’m saying we need to double down even more on public health measures to get us through to the period when enough people in this country will be vaccinated that the virus will have no place to go. It will be a blanket or an umbrella of herd immunity.

We have crushed similar outbreaks historically. We did it with smallpox. We did it with polio. We did it with measles. We can do it with this coronavirus. It requires a highly efficacious vaccine. Thank goodness we have that. We have multiple vaccines, two of which clearly are very efficacious, and I feel confident that the others that are coming along will be comparably efficacious.

Then the second part of that is getting the overwhelming majority of the population vaccinated. I think that likely will have to be about 70 to 75 percent of people in this country. If we do that, that will be the indicator of when things will get back to normal, when you won’t have to worry about going in a restaurant, when you won’t have to worry about having a dinner party, when the children won’t have to worry about going to school, when factories can open and not worry about their employees getting sick and going to the hospital. That will happen, I guarantee you. If people appreciate the importance of getting vaccinated, and we have a high uptake of vaccines, that will happen. That’s what the future will look like.

The future doesn’t need to be bleak. It’s within our hands to really shape the future, both by public health measures and by taking up the vaccine. — Dr. Fauci

What you need to know about the new vaccines

There aren’t enough doses right now for everyone, so initially the vaccine will be rationed for those who need it most. It will take time to produce and distribute the vaccine, and then schedule two vaccinations per person, three to four weeks apart. As more vaccines get approved, things will speed up. At least 40 million doses (enough for 20 million people) should be available from Pfizer and Moderna by the end of the year, and much more will come in 2021.

The challenges ahead for widespread vaccination

The success of the new vaccines will depend on more than how well they performed in a clinical trial. While there’s much reason for optimism, a lot can still go wrong.

First there’s the challenge of manufacturing and distributing the doses. Pharmaceutical manufacturers have struggled to ramp up vaccine production. They have run short on materials like the bags that line the containers in which the vaccines are made. Both of the leading vaccines must be stored in freezing conditions. And state and local governments have to figure out how to get the vaccines from production facilities into people’s arms.

The dark cloud hanging over vaccine distribution

The vaccines will be much less effective at preventing death and illness in 2021 if they are introduced into a population where the coronavirus is raging — as is now the case in the United States.

An analogy may be helpful here, says David Leonhardt, who writes The Morning newsletter for The Times. He explains that a vaccine that’s 95 percent effective, as Moderna’s and Pfizer’s versions appear to be, is a powerful fire hose. But the size of a fire is still a bigger determinant of how much destruction occurs.

Even if the vaccine is distributed at the expected pace, at the current infection level, experts predict that the country would still face a terrible toll during the six months after the vaccine was introduced. Almost 10 million or so Americans would contract the virus, and more than 160,000 would die.

There is one positive way to look at this: Measures that reduce the virus’s spread — like mask-wearing, social distancing and rapid-result testing — can still have profound consequences. They can save more than 100,000 lives in coming months.

Hoping vaccine skepticism will fade

Despite images of relieved health care workers getting a shot in the arm flashing across TV screens and news sites, a new survey finds that more than one-quarter of Americans say they probably or definitely will not get a coronavirus vaccination. The survey, by the Kaiser Family Foundation, found that Republican, rural and Black Americans were among the most hesitant to be vaccinated.

Nevertheless, confidence in the vaccine appears to be rising. Over all, 71 percent of respondents said they definitely would get a vaccination, an 8 percent increase from what Kaiser found in a September survey. Roughly a third (34 percent) now want the vaccine as soon as possible. A recent study from Pew Research showed that about 60 percent of Americans would definitely or probably get a vaccine, up from 51 percent of people asked in September.

Looking ahead to spring

While the majority of Americans won’t get their shots until spring, the vaccine rollout is a hopeful sign of better days ahead. We asked Dr. Anthony S. Fauci, as well as several epidemiologists and health and science writers for The Times, for their predictions about the months ahead. Here’s some of what they had to say.

When can we go to the movies or the theater?

“It depends on the uptake of the vaccine and the level of infection in the community. If you go to April, May, June and you really put on a full-court press and try to vaccinate everybody within a period of a few months, as you go from second to third quarter of the year, then you could likely go to movies, go to theaters, do what you want. However, it’s unlikely, given what we’re hearing about people’s desire to get vaccinated, that we’re going to have that degree of uptake. If it turns out that only 50 percent get vaccinated, then it’s going to take much, much longer to get back to the kind of normality that we’d like to see.” — Dr. Fauci

What did you learn from pandemic life?

“Staying home with my children has taught me that life with fewer errands to run and activities to partake in is kind of nice. I think in the future we will cut down on our family obligations.” — Jennifer Nuzzo, associate professor, Johns Hopkins

What’s one thing you’ll never take for granted again?

“I won’t take traveling to my extended family for granted.” — Alicia Allen, assistant professor, University of Arizona

Will we ever go to a big, crowded, indoor party without a mask again?

“If the level of infection in the community seems substantial, you’re not going to have the parties with friends in congregant settings. If the level of infection is so low that risk is minuscule, you’re going to see back to the normal congregating together, having parties, doing that. If we want to get back to normal it gets back to my message: When the vaccine becomes available, get vaccinated.” — Dr. Fauci


Contributors: Sara Aridi, Quoctrung Bui, Abby Goodnough, David Leonhardt, Apoorva Mandavilli, Donald G. McNeil Jr., Claire Cain Miller, Yuliya Parshina-KottasRoni Caryn Rabin, Margot Sanger-Katz, Amy Schoenfeld Walker, Noah Weiland, Jeremy White Katherine J. Wu and Carl Zimmer

Covid 'Long-Haulers' Need Medical Attention, Experts Urge

Covid Survivors With Long-Term Symptoms Need Urgent Attention, Experts Say

In a two-day meeting sponsored by the N.I.H., officials acknowledged an insufficient understanding of the issues and warned of a growing public health problem.

Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.
Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.Credit…Schaun Champion for The New York Times
Pam Belluck

By

  • Dec. 4, 2020, 12:06 p.m. ET

There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials said this week, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

In a two-day meeting Thursday and Friday, the federal government’s first workshop dedicated to long-term Covid-19, public health officials, medical researchers and patients said the condition needed to be recognized as a syndrome, given a name and taken seriously by doctors.

“This is a phenomenon that is really quite real and quite extensive,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said at the conference on Thursday.

While the number of people affected is still unknown, he said, if long-term symptoms afflict even a small proportion of the millions of people infected with the coronavirus, it is “going to represent a significant public health issue.”

Such symptoms — ranging from breathing trouble to heart issues to cognitive and psychological problems — are already plaguing an untold number of people worldwide. Even for people who were never sick enough to be hospitalized, the aftermath can be long and grueling with a complex and lasting mix of symptoms.

The Centers for Disease Control and Prevention recently posted a list of some long-term symptoms, including fatigue, joint pain, chest pain, brain fog and depression, but doctors and researchers said they still know little about the extent or cause of many of the problems, which patients will develop them or how to address them.

Over the last several months, coronavirus patients with lingering, debilitating health issues have been widely referred to as “Covid long-haulers.” But some survivors and experts feel that name trivializes the experience, lessening its importance as a medical syndrome which doctors and insurers should recognize, diagnose and try to treat. One of the pressing issues patients and experts are now weighing is what official medical term should be adopted to describe the collection of post-Covid symptoms.

“We need to dig in and do the work that needs to be done to help relieve the suffering and stop this madness,” said Dr. Michael Haag, an infectious disease expert from the University of Alabama at Birmingham, who was a co-chair of a session.

In an inadvertent but stark illustration of the difficulty of the recovery process, two of the four patients scheduled to speak at the meeting were unable to because they had recently been rehospitalized. “Those individuals had their acute illness several months ago and they’ve been suffering pretty mightily since then,” Dr. Haag said. “And the fact that they’re still struggling with this gives extra power to what we’re trying to do today.”

Dr. John Brooks, the chief medical officer of the C.D.C.’s Covid response, the co-chairman with Dr. Haag of one session, said he expected long-term post-Covid symptoms would affect “on the order of tens of thousands in the United States and possibly hundreds of thousands.”

He added, “If you were to ask me what do we know about this post-acute phase, I really am hard pressed to tell you that we know much. This is what we’re really working on epidemiologically to understand what is it, how many people get it, how long does it last, what causes it, who does it affect, and then of course, what can we do to prevent it from happening.”

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Presentations from Covid-19 survivors — including Dr. Peter Piot, a world-renowned infectious disease expert who helped discover the Ebola virus — made it clear that for many people, recovering from the disease is not like flipping a switch.

Dr. Piot, who is the director of the London School of Hygiene and Tropical Medicine and a special adviser on Covid-19 research to the president of the European Commission, said he contracted the coronavirus in March and was hospitalized for a week in April. The acute phase of his illness involved some, but not all, of the classic disease symptoms. For example, his oxygen saturation was very low, but he did not develop shortness of breath or a cough until after he got home from the hospital.

For the next month, he experienced a rapid heart rate several hours a day, he said. For nearly four months, he experienced extreme fatigue and insomnia. “What I found most frustrating personally was that I couldn’t do anything,” said Dr. Piot, who now considers himself recovered except for needing more sleep than before his infection. “I just had to wait for improvement.”

Chimére Smith, 38, a teacher in Baltimore who has not been able to work since becoming sick in March, said she had struggled for months to have her symptoms, which included loss of vision in one eye, taken seriously by doctors.

“It’s been a harrowing task and the task and the journey continues,” she said.

Ms. Smith, who is Black, said it was especially important to inform people in underserved communities that long-term effects are “as real and possible as dying from the virus itself.”

The condition, she said, “not only needs to be explored, but it needs to be explained to the same group of people who suffer with being stricken with it the most, and that’s the minority population. I am not just here today for me; I am here for us.”

Hannah Davis, 32, a researcher and artist in Brooklyn, described neurological and cognitive symptoms that began in late March. “I forgot my partner’s name,” she said. “I forgot about sleep. I would regularly pick up a hot pan, burn myself, put it down, and literally do it again. I forgot how to shower. I forgot how to dress myself.”

Months later, some things have improved, but she still struggles to remember things, saying “I feel like I am basically on a 48-hour memory cycle.”

Ms. Davis is part of a long-term Covid survivor group called Body Politic and said a survey of 3,800 of its members in 56 countries has found that 85 percent report cognitive dysfunction, 81 percent had numbness and other neurological sensations, nearly half had speech and language issues and nearly three-quarters had some difficulty working at their jobs.

Clinics treating Covid survivors are seeing a striking number of people with brain fog and other thinking problems, as well as psychological issues, doctors participating in the workshop said.

“Approximately three months after their acute illness, more than half of our patients have at least a mild cognitive impairment,” said Dr. Ann Parker, who co-directs a post-Covid clinic at Johns Hopkins. “We’re also seeing substantial mental health impairments.”

Dr. Janet Diaz, head of clinical care for the World Health Organization’s Covid-19 response, said the agency is planning a meeting focused on long-term coronavirus effects and will soon start collecting data on post-Covid symptoms and medical visits.

She said that while doctors are accustomed to prolonged recovery challenges for people hospitalized for serious illnesses, the lingering symptoms in younger people and those who were not hospitalized for the coronavirus “urgently needs to be better understood and investigated.”