I have written several articles on the coronavirus and on masks. A series of links have been provided at the bottom of this article for your convenience. This article will, however address a different aspect of the virus or on healthcare issues in general.

Table of Contents

–On COVID’s Fifth Anniversary, Scientists Reflect on Mistakes and Successes

–A Disease That Is Milder but Not Gone

–Successes, Failures and Hard-Earned Lessons

–Are We Prepared for Another Pandemic?

–What Covid taught us

–COVID Pandemic Fatigue Has Left the U.S. Vulnerable to New Threats

-The Pandemic’s Toll

-The Many Flavors of Pandemic Fatigue

-COVID’s Continuing Impact

-A Clearer Picture of Covid’s Lasting Effects on the Body

–HHS’s Long COVID Office Is Closing

On COVID’s Fifth Anniversary, Scientists Reflect on Mistakes and Successes

Public health experts discuss lessons learned from the U.S. response to the COVID pandemic, on topics ranging from school closures to trust in science

Five years ago next Tuesday, the World Health Organization declared a global pandemic involving a dangerous new virus—and across the planet, life as we knew it ground to a shuddering halt. But the COVID emergency started well before that. Rewind to late December 2019: hospitals in Wuhan, China, were filling up with cases of a mysterious pneumonia. By January 2020, as the body count started to mount and Wuhan was locked down, other countries began reporting cases. The virus spread like an invisible airborne poison through a cruise ship quarantined off the coast of Japan. Italy became a hotspot of infection. One by one, countries and U.S. states issued stay-at-home orders, and major cities went eerily quiet. Within weeks, New York City hospitals filled up with desperately ill people. The dead piled up so quickly that refrigerated trucks were used as temporary morgues.

Today these events may feel like a distant nightmare for many people. This is not the case for those who lost loved ones or for health care workers who treated people when hospitals were overwhelmed. They will never forget. Still, by most measures, COVID feels nowhere near the dire threat it was in those first few years. People in the U.S. are not being hospitalized and dying of the illness at anywhere close to the rates that occurred in previous years. Experts have varying definitions of what it means for a virus to become endemic, but they agree that the COVID-causing virus SARS-CoV-2 is closer to that state now than it was in the past several years.

“It is not at the level of an emergency that it once was,” says Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health. But she cautions against making assurances. “We’re still not very good at predicting what COVID-19 is going to do,” Nuzzo says.

A Disease That Is Milder but Not Gone

Experts agree that the biggest reason COVID is now causing less death and severe disease is a high level of immunity to SARS-CoV-2. Most of the world’s people have had the disease or been vaccinated against it, or both. Studies estimate the COVID vaccines have saved millions of lives. And in contrast with early 2020, effective treatments—antivirals, including Paxlovid, and common steroid drugs—are now available.

“This winter there’s been a lot of respiratory disease, but relatively little of it has been COVID. And there’s been a continuing trend downward in terms of the total amounts of severe illness and death,” says William Hanage, an associate professor of epidemiology at the Harvard T. H. Chan School of Public Health. Scientists don’t know whether that downward trend will continue, though. “COVID is with us for the long run, as it always was going to be,” Hanage says. “It’s been getting better, but it’s still worth trying to make sure that you don’t transmit it to people who are vulnerable.”

Nevertheless, COVID continues to kill more people than influenza—although the flu has hospitalized more people in the U.S. this winter. And SARS-CoV-2 still triggers localized waves of infection several times a year, wastewater testing reveals. More than seven million people worldwide have died of COVID, though this is likely a gross underestimate. And the virus continues to kill thousands of people every month.

“It’s been a pretty difficult five years for everyone, for the whole world,” says Maria Van Kerkhove, technical lead for COVID response at the World Health Organization. “I think the whole world wants to forget that it happened and move on, which is completely understandable, because we’ve gone through something that has been tremendously difficult,” she says. But “I think we need to make it very clear that COVID is not gone.”

Millions of people had or suffer from long COVID—a catchall phrase describing postviral symptoms that range from mild to debilitating. Scientists have begun studying the causes of long COVID. Evidence suggests vaccines reduce the risk of developing the condition, but treatments remain elusive.

With the worst of COVID seemingly in the rear-view mirror, however, we can finally take stock of what happened and try to make sense of the U.S.’s response.

Successes, Failures and Hard-Earned Lessons

In the early days of the pandemic, scientists and public health experts had to react in real time to a brand-new pathogen—and mistakes were certainly made. U.S. officials botched the initial COVID testing strategy, for example. At first, all tests had to be run through the Centers for Disease Control and Prevention, which created a serious bottleneck. Exacerbating this, the CDC’s test itself turned out to be flawed, making results inconclusive. In future pandemics, testing should be made available much more quickly and widely via the private sector, experts say.

Additionally, public health officials both at the WHO and in the U.S. government were slow to acknowledge that SARS-CoV-2 could spread through tiny airborne particles, or aerosols. Some experts actively warned the public not to wear face masks, arguing either that they were ineffective or that health care providers needed them and should be prioritized amid the initially short supply.

“I think the challenge was the use, specifically, of that word ‘airborne,’ which did have a technical meaning. It took three years to change the terminology related to airborne transmission, and we now say ‘through the air,’” Van Kerkhove says. But she pushes back on the narrative that the WHO didn’t acknowledge the virus’s potential to spread this way. “We had always recommended airborne precautions. In the beginning, it was particular settings, and it was related to health care workers. But then that expanded to other settings” such as gyms and churches, she says. Still, she acknowledges that the messaging could have been clearer.

In those first few days and weeks of uncertainty, as terrifying news about the virus emerged from around the world, by and large, Americans—with some exceptions—initially banded together against a common threat. Gatherings were limited or canceled. Those who could do so stayed home from work or school to help “flatten the curve” of transmission. The goal was to slow the numbers of people getting infected with COVID and becoming severely ill to avoid burdening already overwhelmed hospitals. And in fact, research showed that flattening the curve actually worked. The problem, experts say, is that there was no exit strategy.

“The whole idea of flattening the curve was like a pause button: measures you could employ to buy time to prevent hospitals from becoming overwhelmed, such that you could protect them for six months” or until we had a vaccine, Nuzzo says. But there was no clear end point. “We didn’t have the next phase lined up.”

Hanage agrees that the U.S. could have been smarter with stay-at-home orders. “I also think that we really missed an opportunity in, roughly, the summer of 2020, because by that point in the United States, the initial surges had sort of been brought under control,” he says.

Perhaps no aspect of the U.S. pandemic response has been as fiercely debated as school closures. “The issue of schools and disease is such a political third rail right now that nobody wants to even talk about what, if anything, we should do to protect kids in schools,” says Nuzzo, who wrote a March 2020 op-ed arguing against closing schools.

These closures made some sense in the pandemic’s earliest days and weeks, when the virus’s impacts were still unknown and we lacked even basic treatments, let alone vaccines. Yet many people expressed outrage at how long they went on—or questioned whether they were necessary at all. Some argued that the virus caused milder infections in children; this was generally true, though not in all cases. But protecting kids was not the only point of closing schools; it was also meant to stop chains of transmission to vulnerable adults such as teachers, staff and adult family members.

As time wore on, however, the mental health and social costs of keeping kids home and doing online schooling began to mount. Lengthy, blanket closures could have been replaced by more sustainable interventions such as masking and improving air quality through better ventilation systems.

“I think what really was unfortunate is that the messaging from public health often wasn’t clear, or it was much more definitive than it should have been,” says Michael Osterholm, chair of public health and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Then something happened that negated what we previously said, and it made people challenge how honest we were being—when, in fact, it was never about dishonesty. It was about trying to communicate uncertainty, and that was a real problem.”

Despite these challenges, there were some undeniable triumphs in the scientific response to the pandemic. Within 11 months of the virus being genetically sequenced, the U.S. had developed two mRNA vaccines that prevented severe disease and death extremely effectively. These were the fastest vaccines ever made, says Paul Offit, an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. “To me, the hero of this pandemic is the National Institutes of Health,” whose scientists laid much of the groundwork for the remarkably effective mRNA vaccines, he says. “And then what the Trump administration did was Operation Warp Speed, an $11-billion commitment to basically bet on six horses to win one race, and that was an amazing production of funding.”

But “vaccines do absolutely nothing when they’re sitting there in a vial,” Hanage notes. “They actually need to be in arms.” Unfortunately, vaccines—like many aspects of the pandemic—became politicized amid a steady barrage of blatant lies and misinformation from President Donald Trump and many of his supporters, and a small but vocal part of the population refused to get them. In many areas, people who wore a mask were mocked or berated, and some were physically assaulted. As a result, people in Republican-dominated states and counties died at higher rates than people in Democratic-dominated ones.

The divide highlights just how polarizing the COVID response was. A recent Pew survey found that nearly three in four U.S. adults say the pandemic did more to drive the country apart than to bring it together. Americans have always been individualistic, and many people did not take kindly to being told to wear a mask or get vaccinated—even when such recommendations were aimed at protecting others. The concept of this kind of collective altruism is hard to communicate, and public health messaging often fell short.

“I think the worst possible situation that you can have, when you’re in the middle or the beginning of an evolving pandemic, is the profound degree of divisiveness that we have had and still have in our country,” said Anthony Fauci, the famous doctor and former head of the National Institute of Allergy and Infectious Diseases, in an interview with Scientific American last year. “It’s like being at war. The common enemy is the virus. And we were acting in many situations and in many respects as if the enemy were each other.”

Indeed, Fauci—widely celebrated as a hero and “America’s doctor” early in the pandemic—was ultimately vilified by Trump and many of his followers as the face of stay-at-home orders and other social restrictions. Masking and proof-of-vaccination requirements drew a strong backlash, and a few U.S. counties have since banned masking in public (with some exceptions). Some states have banned COVID vaccine mandates. Such bans may unfairly target disabled and immunocompromised people and could leave the entire population more vulnerable to future disease outbreaks.

Are We Prepared for Another Pandemic?

One thing is certain: the world will experience other pandemics, likely within our lifetime. The most likely culprit would be some type of influenza, as was the case in the 1918 pandemic.

In fact, the U.S. is already battling a steadily growing outbreak of H5N1 avian influenza, or bird flu, which has been infecting wild birds, poultry and, as of March 2024, dairy cattle. The virus is highly deadly to poultry, triggering massive culls that have driven up the price of eggs. Historically, H5N1 hasn’t been readily transmitted to humans. But in the few outbreaks that have occurred among people, it has had a staggering mortality rate of almost 50 percent. In the current outbreak affecting dairy cattle and poultry in the U.S., 70 human cases—most of them mild—and one death have been reported.

Experts have criticized the H5N1 response among federal and state health agencies, warning that testing has been insufficient and that infections are likely being missed. Dairy farms have been reluctant to test for the virus over worries about losing income, and farm workers—many of whom are undocumented—often fear losing their jobs or being deported if they seek medical care. The election of an intensely anti-immigrant president has only exacerbated these fears.

It’s far from certain that H5N1 will become a pandemic. The virus would need to mutate to a form that spreads easily between humans, which apparently hasn’t happened yet. But if and when we in the U.S. do face a pandemic, regardless of what causes it, in some ways we may now actually be worse equipped than we were when we faced COVID.

“Right now I think we’re less prepared for the next pandemic than we were in 2020,” Osterholm says. “One of the most important weapons we have in a fight against [a pandemic virus is trust in] public health recommendations. And I think that, at this point, that’s a huge issue for the public, in terms of not trusting vaccines.”

Current threats to the institution of science itself are exacerbating the problem. Trump has nominated some overtly antiscience and antivaccine people—most notably Secretary of Health and Human Services Robert F. Kennedy, Jr.—to lead federal health agencies. He has made sweeping cuts to the CDC, the NIH and other science agencies. And in one of Trump’s first executive orders, he announced plans to withdraw the U.S. from the WHO.

“You have a public health infrastructure that is falling apart,” Offit says. You have people that are heads of various agencies—like NIH or CDC or [Food and Drug Administration] and now [the Department of Health and Human Services]—that have disdain for those agencies, that don’t trust those agencies.”

Yet in other ways, we may be slightly better prepared, Nuzzo adds. “People have lived through a pandemic recently, and they remember it to some extent,” she says. Unlike what happened with COVID, if an influenza pandemic were to hit us, we would be able to use tests for the virus and some vaccines that we have already stockpiled. “People generally understand influenza disease. We’ve been studying H5 infections for 25 years, so we know a bit about the virus and how it affects the body,” Nuzzo says. “That said, there are going to be challenges.” [Editor’s Note: H5 is a subtype of bird flu that includes H5N1 and other viruses.]

The WHO’s Van Kerkhove agrees we are more ready in some ways and less so in others. “We are [better prepared] because we’ve all gone through this, and what we learned at the beginning of COVID was: countries that had the trauma and experience of these types of outbreaks—with SARS, with MERS, with avian influenza—were better prepared. They acted fast. They knew how bad it would be. And so now every country has that experience.”

But maintaining that level of preparedness is a challenge. “How do we keep up the momentum and the pressure on governments and organizations and institutions to make sure that we continue to invest in public health, we continue to invest in prevention? Prevention is a very hard sell,” Van Kerkhove says.

She hopes the U.S. will change its mind about working with the WHO and other countries. “I think it is in all member states’ best interest to work collectively together on pandemic preparedness, on surveillance, detection, risk assessment,” Van Kerkhove says, “because these pathogens don’t respect borders.”

What Covid taught us

When the pandemic upended our lives five years ago today, it gave researchers a rare chance to learn more about who we are and how we live. The entire world changed at once, creating natural experiments everywhere. What happens when sports teams play in empty stadiums? When the government sends people money? When women stop wearing high heels? When children stop going to school?

In many cases, it was impossible to know what caused the specific changes — some aspect of the Covid pandemic or another invisible influence. But the findings demystified several aspects of our world. My colleague Irineo Cabreros and I wrote about them in a story we published today. Here are some highlights:

Crowds help the home team

When sports teams played in empty stadiums, research showed that yes, the fans made a difference: Home teams played worse without them around. They were less likely to win at home and had poorer performances. The effect was smaller for teams already accustomed to smaller crowds. But the home advantage wasn’t just about fans. When the N.B.A. restarted play, the top 22 teams isolated in Orlando, Fla., allowing researchers to study the effects of jet lag. Rebounding, shooting accuracy and wins were all higher among players who hadn’t traveled across time zones.

Virtual doctor visits work …

Telehealth, once uncommon, accounted for half of medical visits early in the pandemic. Mostly, patients and doctors were satisfied with seeing one another online. Telehealth lowered health care costs. It was especially useful for treating chronic illnesses and for psychotherapy. And in some cases, the pandemic revealed, people don’t need to see a doctor at all. The number of patients showing up with mild appendicitis decreased, while the number with complicated appendicitis didn’t change, which suggested that some people who would typically have had surgery recovered on their own.

… but virtual school doesn’t

Liana Finck

When it came to learning, remote schooling wasn’t enough. Across the country, in rich and poor districts, and among white, Black and Hispanic students, test scores in reading and math fell. Many students still haven’t caught up. There was learning loss even in countries that had shorter school closures than the United States did. But the data is clear: The sooner children returned to classrooms, even part time, the better they did.

COVID Pandemic Fatigue Has Left the U.S. Vulnerable to New Threats

(3/13/2025 12:35 PM)

During the five-plus years that COVID has existed, our conception of the virus that causes it has been a slippery thing. It has been a terrifying mystery and a daily reality, a killer pathogen and “just the flu,” an alphabet of variants that burst on the scene only to disappear from public consciousness.

Amid all this morphing, what has stayed constant is that COVID has been, in one way or another, wearying in a bone-deep way. It was tiring to disinfect surfaces and then to learn that the virus was in fact airborne. It was tiring to scramble for toilet paper, for masks, for vaccines. It was tiring to fear an invisible virus and to stay away from other people. And it has been tiring to return to society—whether with abandon, fear or something in between.

Regardless of how each of us has responded to the virus’s threats, its shadow has haunted our lives for five years in ways we never even thought to imagine before we encountered the then novel coronavirus SARS-CoV-2. “I think we’re all exhausted, and we’re not actually admitting it,” says Alexandre White, a sociologist and historian of medicine at Johns Hopkins University. That’s a problem, he says. “There’s real power in mourning and real power in memorial,” White says. “I think we’ve too easily moved on from COVID in such a way that we assume that since we all lived through it, there’s nothing really more to talk about, and I think that there’s a lot more to talk about.”

Discussing how each of us experienced the past five years and its many stressors—and listening to others do the same—could be a way to heal the rifts that COVID has left in U.S. society.

The Pandemic’s Toll

Not long after COVID hit the U.S. in earnest, the phrase “quarantine fatigue” had come into use. As the days turned to months, the language morphed into “pandemic fatigue.” But the fatigue itself has had countless sources over the years, and the term has often encompassed many more emotions than simply fatigue, including loneliness, sadness, anger, fear and boredom.

Each person’s experience was influenced by a host of factors. The most severe one, of course, has been death—so much death. In 2020 COVID killed or contributed to the deaths of at least 385,000 people in the U.S. And in 2021 the number was more than 463,000, according to the Centers for Disease Control and Prevention. Losing family members early, without proper deathbed visits or funerals, brought a particular type of pain. And while their rate has declined, the deaths have continued. As of March 6, the five-year death toll was 1,225,281 people. Even now, the tally grows by hundreds every week.

Those of us who have so far escaped COVID without it stealing loved ones have nonetheless faced grief, stress and fear, particularly during the early weeks and months of the pandemic, that were unthinkable to many Americans in 2019.

Medical professionals suffered high rates of burnout and moral injury. The people classified as essential workers—grocery cashiers and farm workers, delivery drivers and electricians—found themselves suddenly risking their lives for their jobs. Children abruptly had to learn from a screen, while working parents, particularly mothers, attempted to simultaneously oversee a makeshift classroom. Proms and holiday gatherings, happy hours and vacations were all canceled.

In October 2024 half of U.S. adults surveyed about their experience said that COVID took a minor toll on their lives; another quarter say it took a major one. Thirty percent overall said they had experienced a toll that they had not or only somewhat recovered from.

It’s not surprising that COVID’s acute stages took a toll in the U.S.—or that the recovery has been difficult here. The country was out of practice when it came to dealing with pandemics. Many of the disease scares of recent decades—SARS, MERS, Ebola, Zika—in large part spared the U.S. Even the swine flu of 2009, which killed 12,500 people in the country within its first year, fizzled out in less than two years. The spread of HIV/AIDS has been devastating, but its transmission routes have allowed many Americans to feel isolated from its threats. The previous most severe respiratory epidemic the U.S. faced was the influenza pandemic of 1918, a full century before COVID.

The 1918 pandemic was very different from the rise of COVID in 2020, says Nancy Tomes, a historian at Stony Brook University. In the U.S. the bulk of influenza infections occurred during just a couple of months in the fall of 1918 and while the nation was at war.

People were used to devastating infectious diseases in the early 20th century—still, the U.S. public struggled with pandemic restrictions. “Even at a time when the majority of Americans had experience with deadly infectious diseases and were much easier to scare, they had trouble changing their behavior to prevent the spread of something fast-moving,” she says.

Since then scientists and doctors have had some success in taming germs, thanks to the twin wonders of vaccines and treatments, Tomes says. “Americans had started to expect that there’s a drug for everything and a vaccine for everything”—and that “if there is a dangerous new disease and there isn’t an immediate cure or vaccine for it, somebody has done something wrong,” she says.

The Many Flavors of Pandemic Fatigue

When COVID first hit, many people leaned into their communities, making sacrifices in attempts to protect neighbors and loved ones. But as time went on, communal thinking seemed to fray in the face of clear challenges. Solidarity disintegrated as a host of factors lumped into a diagnosis of “pandemic fatigue” took root.

Scientists scrambled to understand COVID and the virus that caused it—with some remarkable success. But to everyday people living in fear, the process was a far cry from the grade-school vision of how settled science works. “This was a lot more uncertain,” says Richard Carpiano, a public health scientist and sociologist at the University of California, Riverside. “What the public really got out of this was a front-row seat to watching science unfold.”

Early in the pandemic, some people who survived COVID didn’t fully recover. These “long haulers,” as they were soon dubbed, fought against medical systems that didn’t expect the new virus to trigger an array of disabling long-term conditions that came to be known as long COVID. Today people with this condition are learning how limited support for people with such disabilities can be in the U.S.

“While a virus was invading people’s bodies, it also really crept into these fault lines of our society and our culture.” —Richard Carpiano, public health scientist and sociologist

Unsurprisingly, COVID hit society’s least-privileged members hardest: people of color, low-income people and the elderly. “Inequality haunts every epidemic,” White says. “Epidemics can cause inequities in a society, but more often than not, they prey very effectively on the existing inequities within the population.”

Pandemic action plans failed to account for opposition to safety measures, including school closures, mask mandates and vaccination, says Andrew Lakoff, a medical anthropologist at the University of Southern California. Political actors seized on this dissent to drive people apart. “We were suffering from anxiety and a lot of people getting sick and dying, and the social fabric was getting torn apart,” he says.

Despite the virus’s novelty, scientists produced effective vaccines against it on a miraculously short time line, deploying them within a year after infections began. But existing antivaccine efforts that focused on childhood vaccines and targeted mainly parents also moved fast, latching on to the new vaccines. “The COVID vaccine that the whole population had to take diffused a lot of the antivaccine discourse into the general public,” Carpiano says.

Throughout it all, medical professionals who had risked their lives from the beginning found themselves not only still facing a constant onslaught of patients but now also trying to squash misinformation and denial about the disease.

As these threats built and COVID continued to bulldoze its way across the U.S, people moved away from collective care for one another’s health. COVID shots became an annual ritual for some, but only one in every four or five adults in the U.S. now gets the vaccine. Only 4 percent of U.S. adults report regularly wearing a mask, which reduces transmission of not only COVID but also colds, the flu and other respiratory infections. “COVID was a radical test of collective unity, and America deeply unveiled its individualism and lack of collective heart,” says Emily Mendenhall, a medical anthropologist at Georgetown University.

COVID’s Continuing Impact

Whatever the source of fatigue, the U.S. public generally was eager for the COVID pandemic to end. “Pandemics end when a sizable proportion of the population feels that they’re not at risk from the disease anymore,” White says. This occurs regardless of how accurate the assessment is or how poorly it applies to the rest of the population. “There’s a certain luxury in claiming a pandemic’s ending,” he says.

In March 2025 it’s easy to feel the world is just as chaotic as it was five years ago—or worse. “I think people are sick of talking about COVID, and I don’t think it’s because people don’t care,” Mendenhall says. “I think it’s just because there are so many more pressing issues right now.”

The pandemic pushed U.S. society past its limits in ways that continue to reveal themselves. Donald Trump is president again, politics are more divisive than ever, and bird flu threatens to become the next human pandemic, even as the president is axing science and social safety nets.

The timing may not be a coincidence, given how the pandemic made people reevaluate their relationship with the government and the role they want it to play in their lives. “While a virus was invading people’s bodies, it also really crept into these fault lines of our society and our culture,” Carpiano says. “It makes us think about our social contract with our government in terms of what it means to provide for our well-being and for our safety.”

None of these trends bodes well for the U.S.’s ability to effectively respond to the next public health crisis—whether it’s avian influenza or something else. White sees a sharp contrast with the 1918 pandemic: by its end, no one wanted to talk about it, but its memory helped inspire the creation of the World Health Organization and other antipandemic measures. Today it’s primarily community organizers and long COVID activists, as well as public health experts, who are leading efforts to turn the painful experience of COVID into something that can help prepare us for future disease threats.

“Pandemic preparedness is not a last-ditch solution; it’s really a constant set of strategies for monitoring such threats,” White says. “I’m concerned today with pandemic defeatism—where rather than maintain systems prepared for another pandemic or continue combating COVID-19, we might be too quickly choosing to ignore the very real risks that are out there and instead throw up our hands, suggesting that there’s perhaps nothing we can do.”

In our exhaustion, that strategy may sound appealing. But it risks even more dire consequences than the ones COVID has brought. “That would be such an incomprehensible tragedy,” White says. “We can do better—and we have to do better, for each other.”

A Clearer Picture of Covid’s Lasting Effects on the Body

(3/21/2025 6:37 AM)

Five years — and hundreds of millions of cases — after the World Health Organization declared the Covid-19 pandemic, scientists are getting a clearer picture of how the virus can affect the body long after an infection seems to pass.

Some of Covid’s effects became apparent soon after the virus began spreading. We quickly understood how deadly an infection could be, especially for those with underlying conditions like diabetes and heart disease. But it has taken years of research to start making sense of how a bout of Covid can lead to lasting, sometimes invisible changes in different parts of the body.

Some of these effects, such as chronic fatigue and brain fog, are considered long Covid, defined as symptoms from an infection that persist for at least three months. By some estimates, 400 million people worldwide have been diagnosed with some form of long Covid. But an infection can also lead to other issues, including lung and heart damage and microbiome changes in the gut, that may not always be recognized as long Covid but can still have a lasting effect on our health.

We now have a better sense of what might be behind those changes, including the role of the widespread inflammation that Covid can cause. For most people, inflammation will subside once the virus clears. But for some, if it “rages” too intensely or persists as a “slow burn” for too long, it can wreak havoc around the body, said Dr. Braden Kuo, a neurogastroenterologist at Massachusetts General Hospital.

Here’s what scientists have learned so far about inflammation and the other factors driving these effects.

The Lungs

Covid irritates the lungs and can cause long-term issues, like persistent shortness of breath and coughing. In rare cases, Covid can lead patients to develop pneumonia and leave scarring and small masses of tissue, called nodules, throughout the lungs. Those scars can make it harder to breathe. Small studies have suggested that over 10 percent of people hospitalized with a Covid infection had lung scarring and other issues two years later.

More on Covid-19

• Enduring Changes: We asked Americans what changes forged in the upheaval of the pandemic have lasted — for better and for worse.
• How N.Y.C. Has Changed: The economy has largely recovered and America’s most populous city is finally growing again, but the New York City that has emerged from the pandemic is a place of greater extremes.
• Schools and the Next Pandemic: The devastating impact of school closures on children and adolescents is widely acknowledged. Here is what leaders say they may do next time.
• Gut Issues: We asked experts why Covid causes diarrhea, constipation, pain and bloating, and what to do about these conditions.
• Heart Problems: One recent study found that a Covid infection doubled the risk of a major cardiovascular event for up to three years afterward. People who had severe infections were especially vulnerable.

The cause: The virus invades cells along the airways, causing inflammation that can attack and sometimes destroy healthy lung tissue. This can impair the lungs’ ability to deliver oxygen throughout the body, said Dr. Ziyad Al-Aly, a senior clinical epidemiologist at Washington University in St. Louis.

As the lungs try to recover and repair, they form scars. But scar tissue itself can stiffen the lungs and reduce lung capacity, leading to lasting symptoms such as a cough and shortness of breath.

The Gut

Covid can cause short-term symptoms like nausea, vomiting and diarrhea.

But in some people, Covid can lead to chronic gastrointestinal problems, like reflux, constipation, diarrhea and abdominal pain. These issues can last for months or even years. In a 2024 study, researchers estimated that bouts with Covid had left as many as 10 percent of people with lasting abdominal pain and 13 percent with gastrointestinal issues a year later.

The cause: Scientists don’t know why, exactly, Covid can throw off normal gut function so much — but they’re getting a better understanding of what might be at play. For example, it’s now clear that the virus can disrupt the gut microbiome, reducing beneficial microbes and increasing the numbers of harmful ones. “Good” microbes can help tamp down inflammation while “bad” ones can increase it.

Inflammation from the infection itself, as well as from the altered gut microbes, might harm the lining of the intestine. This can allow toxins and the broken-down components of food to escape from the gut into other tissues of the body. Immune cells might then mount an allergy-like response to certain foods, leading to food intolerances.

Inflammation may also “chew away” at the nerves that signal pain in the gut or that control the intestinal contractions that keep food moving along, Dr. Kuo said. This can cause stomach or intestinal pain or make food move too fast or too slow through the digestive tract, resulting in symptoms like diarrhea or constipation.

The Brain

At the height of an infection, patients often develop headaches and can feel dizzy and confused. They sometimes struggle to find the right words, have difficulty concentrating or following a conversation or find they have gaps in their memory.

These symptoms can linger: Studies have found that roughly 20 to 30 percent of people infected with Covid experienced brain fog at least three months after an initial infection. Research also shows that Covid can lead to conditions like anxiety or depression, or exacerbate existing mental health issues.

The cause: Scientists are still working to identify all the factors that contribute to lasting neurological issues after Covid. But one culprit seems clear: persistent inflammation, which damages neurons and inhibits the creation of key connections between synapses. All of this may cause symptoms like those described above. Some researchers also think that areas of the brain involved in cognition and emotion are particularly vulnerable to inflammation, which helps explain why an infection can induce or worsen mental health issues.

Another theory is that the virus disrupts the blood-brain barrier, which protects brain tissue and is vital for cognitive function.

Fragments of the virus may also linger in the brain long-term, which could explain why some cognitive symptoms last beyond the initial infection.

The Heart

A Covid-19 infection increases the risk of heart problems, including heart attacks, strokes, damage to the heart muscle and an irregular heart beat, known as an arrhythmia. One large study found that having Covid doubled the risk of a major cardiovascular event for up to three years.

The cause: When you have an acute Covid infection, the stresses of fever and inflammation can place excess demand on the heart. In someone who already has plaque buildup in the arteries or heart muscle that’s started to become stiff, that demand can lead to an irregular heartbeat or heart attack.

But more common, scientists think, is that the virus provokes inflammation that injures the heart muscle. The virus may also damage the cells lining the blood vessels, leading to inflammation there. This could cause a new clot to form or make existing plaque break off and clog a blood vessel. That type of blockage can cause sudden death from a heart attack or lead to downstream damage to heart muscles and other tissue, which can result in heart failure or an arrhythmia.

People who have been hospitalized for Covid have the highest short- and long-term risk of heart complications. Some research suggests that people with a non-O blood type — A, B or AB — have a particularly increased risk, perhaps because blood type may be linked to how the blood clots.

The Circulatory System

Studies of patients with long Covid show that their bodies have trouble moving blood out of the legs and abdomen and back up to the heart. That can reduce the amount of blood the heart pumps out, causing fatigue, shortness of breath and a feeling of being unwell after exercise.

The cause: It’s not clear why these circulatory problems happen, but scientists hypothesize that in some patients, inflammation harms certain nerve fibers outside the brain and spinal cord that regulate the squeezing ability of blood vessels. This could result in impaired blood flow, said Dr. David Systrom, a pulmonary and critical care physician at Brigham and Women’s Hospital in Boston.

In some patients with long Covid, it also appears that the muscles are less able to extract oxygen from the blood than normal, hampering their ability to keep up with exercise, Dr. Systrom said. In addition, the mitochondria — the energy-producing powerhouses of cells — may not work properly or at full capacity, delivering another hit to muscle tissue.

HHS’s Long COVID Office Is Closing. What Will This Mean for Future Research and Treatments?

(4/1/2025)

Under orders from the Trump administration, the U.S. Department of Health and Human Services is planning to close its Office for Long COVID Research and Practice (OLC). This governmental office orchestrates efforts across health agencies to understand and treat long COVID, a mysterious postviral condition that affects an estimated 23 million people in the U.S. today. The closure is another casualty of the administration’s reorganization of various governmental departments, according to an internal e-mail from the OLC’s director Ian Simon.

“Over the last 3+ years, we have built meaningful connections and fruitful collaborations across the federal landscape to support this work,” Simon wrote. “While our office is closing, we hope that the work we have been dedicated to will continue in some form.”

The closure sends a harrowing message to the many adults and children who are still navigating the complex condition, says Ziyad Al-Aly, a leader in long COVID research and a clinical epidemiologist.

“People have been scarred by this pandemic in the form of long COVID, and their disease is real and requires help,” Al-Aly says. “The intent of the office was to really catalyze progress and realize efficiencies. Undoing it risks undoing a lot of the work, delaying a lot of progress, and [it] really is a disservice today to the more than 20 million Americans who are suffering from long COVID.”

What Did the Long COVID Office Do?

Various health agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention and the Agency for Healthcare and Research Quality (AHRQ), had begun early research on long COVID in 2020. The OLC was created in 2023 to serve as a “quarterback,” Al-Aly says, helping those agencies coordinate and efficiently run various long COVID initiatives. These have included the CDC’s program to train clinicians in timely diagnosis, prevention, and treatment and AHRQ’s Long COVID Care Network (an initiative to provide funding and support to several existing long COVID clinics across the U.S.). The networks’ clinics have focused particularly on expanding care to underserved, rural, vulnerable and marginalized communities. The OLC supported other programs that addressed stigma and health disparities associated with long COVID, such as by creating standards for research studies to include racial and ethnic groups that have been disproportionately affected by the condition.

What Does the Closure Mean for Affected People and Research?

The World Health Organization estimates six in 100 people infected with the COVID-causing virus SARS-CoV-2 will develop long COVID, which includes a sweep of mild to devastating symptoms that can persist for months or years. The causes, the puzzling range in severity, and future treatments and cures have been prime areas of interest for the OLC.

Long COVID has proved to be a complex condition, and while some treatments may help alleviate symptoms, there isn’t a cure. But Al-Aly says much progress has been made, and he notes that the office has supported hundreds of long COVID studies.

While people currently under treatment for long COVID might not see immediate consequences, the OLC’s closure will have a “chilling effect,” Al-Aly says. Groups that advocate for people with long COVID, such as the COVID-19 Longhauler Advocacy Project, have echoed this sentiment, expressing concerns about future investment and care for an overlooked condition.

“This isn’t just about an office being closed. It’s about the erasure of tens of millions of people,” the founder of the Longhauler Advocacy Project wrote in a recent statement. “The Office was our strongest ally. The team was deeply empathetic, mission-driven, and understood the urgency of the crisis we are living through. It was the first and only government entity with the ability to unify all HHS agencies—to ensure efforts weren’t duplicated or contradictory, to establish true coordination, and to finally treat Long COVID like the systemic, multisector challenge it is. For the first time, we had many efforts underway and ready to launch, and the infrastructure to act as one country. That’s all gone now.”

Other Initiatives under Threat

The shuttering of the OLC coincides with other recent moves to deprioritize research efforts related to COVID and pandemic preparedness.

On Tuesday Science reported that it had learned that several principal investigators of research projects on antiviral drugs, COVID vaccines and long COVID received letters that their grant funding was effectively terminated. In a statement to Science, HHS wrote that the agency “will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago.”

“It’s kind of like saying, ‘You’ve been through an earthquake, but the earthquake is over,’” Al-Aly says. “So don’t complain to me that the building is destroyed. Don’t complain to me that you’re injured. I’m not seeing the earth shaking. It’s over.’ This is how this feels to us—the people who are working and thinking about long COVID and patients with long COVID.”

Additionally, a former AHRQ employee recently told STAT that grant funding that supports the Long COVID Care Network may also be in jeopardy because the Trump administration has targeted the agency and reduced its staffing.

If the OLC’s closure was also intended to be a cost-saving move, it should be considered that the funding to run the office is “peanuts” amid the government budget, Al-Aly adds. And it doesn’t compare to the costs of long COVID to the U.S. economy: a 2022 preprint analysis by a Harvard University economist estimated those costs to be $3.7 trillion.

Betsy Ladyzhets, a long COVID reporter and co-founder of the long COVID news website the Sick Times, reported that during the government information purge conducted in the wake of executive orders issued by President Donald Trump, a federal website for the U.S. Department of Labor’s Job Accommodation Network took down long COVID’s status as a disability—along with resources and accommodation information.

The unwinding of long COVID initiatives and information is particularly confounding, given new Secretary of Health and Human Services Robert F. Kennedy, Jr.’s platform to tackle chronic illness in the U.S. During his confirmation hearings, Kennedy avidly pledged to invest in long COVID research and the development of new treatments.

“I understand there is this enthusiasm to support chronic disease. Well, long COVID is the exemplar of chronic disease,” Al-Aly says. “I would like to remind RFK, Jr. that he told the nation in his confirmation hearing that he’s going to prioritize research on long COVID…. The actions over the past several days don’t really align with that, to be honest. You said you want to prioritize long COVID, you said you want to help with chronic disease and ‘Make America Healthy Again,’ and that’s not what we’re seeing now.”

Resources

scientificamerican.com, “On COVID’s Fifth Anniversary, Scientists Reflect on Mistakes and Successes: Public health experts discuss lessons learned from the U.S. response to the COVID pandemic, on topics ranging from school closures to trust in science.” By Tanya Lewis; The NYTimes, The Morning, “What Covid taught us.” By Claire Cain Miller; scientificamerican.com, “COVID Pandemic Fatigue Has Left the U.S. Vulnerable to New Threats.” By Meghan Bartels; nytimes.com, “A Clearer Picture of Covid’s Lasting Effects on the Body.” By Dani Blum, Nina Agrawal and Alice Callahan; scientificamerican.com, “HHS’s Long COVID Office Is Closing. What Will This Mean for Future Research and Treatments?” By Lauren J. Young;

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