An analysis of health insurance records of almost 2 million coronavirus patients found new issues in nearly a quarter — including those whose Covid infection was mild or asymptomatic.Hundreds of thousands of Americans have sought medical care for post-Covid health problems that they had not been diagnosed with before becoming infected with the coronavirus, according to the largest study to date of long-term symptoms in Covid-19 patients.The study, tracking the health insurance records of nearly 2 million people in the United States who contracted the coronavirus last year, found that one month or more after their infection, almost one-quarter — 23 percent — of them sought medical treatment for new conditions.Those affected were all ages, including children. Their most common new health problems were pain, including in nerves and muscles; breathing difficulties; high cholesterol; malaise and fatigue; and high blood pressure. Other issues included intestinal symptoms; migraines; skin problems; heart abnormalities; sleep disorders; and mental health conditions like anxiety and depression.Post-Covid health problems were common even among people who had not gotten sick from the virus at all, the study found. While nearly half of patients who were hospitalized for Covid-19 experienced subsequent medical issues, so did 27 percent of people who had mild or moderate symptoms and 19 percent of people who said they were asymptomatic.“One thing that was surprising to us was the large percentage of asymptomatic patients that are in that category of long Covid,” said Robin Gelburd, president of FAIR Health, a nonprofit organization that conducted the study based on what it says is the nation’s largest database of private health insurance claims.More than half of the 1,959,982 patients whose records were evaluated reported no symptoms from their Covid infection. Forty percent had symptoms but didn’t require hospitalization, including 1 percent whose only symptom was loss of taste or smell; only 5 percent were hospitalized.Ms. Gelburd said the fact that asymptomatic people can have post-Covid symptoms is important to emphasize, so that patients and doctors can know to consider the possibility that some health issues may actually be aftereffects of the coronavirus. “There are some people who may not have even known they had Covid,” she said, “but if they continue to present with some of these conditions that are unusual for their health history, it may be worth some further investigation by the medical professional that they’re working with.”The report, which will be posted publicly on Tuesday morning on the organization’s website, analyzed records of people diagnosed with Covid-19 between February and December 2020, tracking them until February 2021. It found that 454,477 people consulted health providers for symptoms 30 days or more after their infection. FAIR Health said the analysis was evaluated by an independent academic reviewer but was not formally peer-reviewed.“The strength of this study is really its size and its ability to look across the range of disease severity in a diversity of age groups,” said Dr. Helen Chu, an associate professor of medicine and infectious diseases at the University of Washington School of Medicine, who was not involved in the report. “This is a hard study to do with that much data.”The report “drives home the point that long Covid can affect nearly every organ system,” said Dr. Ziyad Al-Aly, chief of the research and development service at the VA St. Louis Health Care System, who was not involved in the new study.“Some of these manifestations are chronic conditions that will last a lifetime and will forever scar some individuals and families,” added Dr. Al-Aly, who was an author of a large study published in April of lingering symptoms in Covid patients in the Department of Veterans Affairs health system.In the new study, the most common issue for which patients sought medical care was pain — including nerve inflammation and aches and pains associated with nerves and muscles — which was reported by more than 5 percent of patients or nearly 100,000 people, more than a fifth of those who reported post-Covid problems. Breathing difficulties, including shortness of breath, were experienced by 3.5 percent of post-Covid patients.Nearly 3 percent of patients sought treatment for symptoms that were labeled with diagnostic codes for malaise and fatigue, a far-reaching category that could include issues like brain fog and exhaustion that gets worse after physical or mental activity — effects that have been reported by many people with long Covid.Other new issues for patients, especially adults in their 40s and 50s, included high cholesterol, diagnosed in 3 percent of all post-Covid patients, and high blood pressure, diagnosed in 2.4 percent, the report said. Dr. Al-Aly said such health conditions, which have not been commonly considered aftereffects of the virus, make it “increasingly clear that post-Covid or long Covid has a metabolic signature marked by derangements in the metabolic machinery.”Relatively few deaths — 594 — occurred 30 days or more post-Covid, and most were among people who had been hospitalized for their coronavirus infection, the report found.The study, like many involving electronic records, only addressed some aspects of the post-Covid landscape. It did not say when patients’ symptoms arose or how long the problems persisted, and it did not evaluate exactly when after infection patients sought help from doctors, only that it was 30 days or more.The database included only people with private health insurance or Medicare Advantage, not those uninsured or covered by Medicare Parts A, B and D, Medicaid or other government health programs. Dr. Chu said people without insurance or with incomes low enough to qualify for Medicaid are often “more likely to have worse outcomes,” so the findings may understate the prevalence of some post-Covid health problems or may not represent the full picture.In addition, diagnostic codes in electronic records are “only as good as what is documented by the provider who saw the patient,” said Dr. Chu, a co-author of a smaller study of post-Covid symptoms among patients at the University of Washington.For example, neurological or cognitive issues like brain fog may be underreported because doctors may not find an appropriate diagnostic code or patients may not be seeking medical help for that specific issue, FAIR Health said.It’s also possible that some people classified as having asymptomatic Covid-19 infections developed symptoms after they tested positive. And some people who received their first diagnosis of a medical issue like hypertension or high cholesterol post-Covid might have previously had those issues but never sought or received treatment.Another limitation of the study is that it did not compare people who had Covid-19 with those who did not, making it unclear if rates of post-Covid symptoms were higher than in a more general population. Dr. Al-Aly’s study, which made such a comparison, found that between one and six months after becoming infected with the coronavirus, patients who’d had Covid had a 60 percent greater risk of death and a 20 percent greater chance of needing outpatient medical care than people who had not been infected.The FAIR Health report excluded patients with certain serious or chronic pre-existing conditions like cancer, kidney disease, H.I.V., liver disease and stroke because researchers said it would be difficult to separate their previous health status from post-Covid symptoms.The report did not explore connections between other pre-existing conditions patients had and their likelihood of developing post-Covid symptoms. But it said that people with intellectual disabilities or those with Alzheimer’s disease or dementia had a greater risk of dying 30 days or more after their infection.Overall, experts said, the report’s findings underscore the widespread and varied nature of post-Covid symptoms.“People with long Covid need multidisciplinary care,” said Dr. Al-Aly, “and our health systems should adapt to this reality and develop capacity to deal with these patients.”

A small study found that six months after hospitalization, most children with MIS-C did not have debilitating health issues. But some had lingering muscle weakness and emotional difficulties.Children who get sick from the rare but serious Covid-related inflammatory syndrome may surmount their most significant symptoms within six months, but they may still have muscle weakness and emotional difficulties at that time, a new small study suggests.Published in the journal Lancet Child and Adolescent Health on Monday, the study appears to be the first detailed look at the health status of children six months after they were hospitalized with the condition, called Multisystem Inflammatory Syndrome in Children. The syndrome typically emerges two weeks to six weeks after a Covid-19 infection that is often quite mild, and it can result in hospitalizations for children with severe symptoms involving the heart and several other organs.A major question has been whether children who survive MIS-C will end up with lasting organ damage or other health problems. The new study, of 46 children under 18 who were admitted to a London hospital for MIS-C (it has a different name and abbreviation, PIMS-TS, in Britain), suggests that many of the most serious problems can resolve with time.“To be honest, I think we all didn’t know what to expect,” said Dr. Justin Penner, a pediatric infectious disease physician at the hospital involved in the study, Great Ormond Street Hospital, known as GOSH. “We didn’t know which body systems would require assistance or become a problem one month, three months, six months down the line.”The children in the study were hospitalized between April 4 and Sept. 1, 2020, part of the first wave of the inflammatory syndrome. Many were quite sick. They all had systemic inflammation, and most had symptoms involving multiple organ systems, such as the heart, kidneys or circulatory system. Forty-five children had gastrointestinal symptoms, and 24 had neurological symptoms such as confusion, memory problems, hallucinations, headaches or problems with balance or muscle control.Sixteen of the children were placed on ventilators, 22 needed medication to help their hearts pump more effectively and 40 were treated with immunotherapies like intravenous immunoglobulin. All survived.Six months after they were discharged from the hospital, only one child still had systemic inflammation, just two children had heart abnormalities and six children had gastrointestinal symptoms. All but one child was able to resume school, either virtually or in person.Still, 18 of the children were experiencing muscle weakness and fatigue, scoring in the bottom 3 percent for their age and sex on the six-minute walking test, a standard test of endurance and aerobic capacity. And 15 children were experiencing emotional difficulties like anxiety or severe mood changes, according to questionnaires answered by either the parents or the children.In the United States, 3,742 young people age 20 and under have developed the syndrome, and 35 have died, according to the most recent data from the Centers for Disease Control and Prevention. A major study of long-term outcomes has already recruited 600 children and will follow them for five years, according to a leader of that effort, Dr. Jane Newburger, associate chief for academic affairs in the cardiology department at Boston Children’s Hospital.Dr. Newburger, who was not involved in the British report, called it a “small but important study” that “contributes new information to the knowledge gap about long-term effects of MIS-C.”She and the authors themselves noted that there were limitations to the findings because the children in the study were not compared with a control group of children without MIS-C or those with other illnesses. It is unclear, for example, if their emotional problems and muscle weakness were the result of the syndrome, the process of being hospitalized for an illness or other stressors during this time. “Mental health and physical conditioning have taken a hit in children and adolescents in general during the pandemic,” Dr. Newburger said.Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, who was not involved in the new study, said it might be difficult to tease out which residual problems were directly attributable to the syndrome and which might have resulted from any critical illness. He said the fact that some of the children still had trouble with muscle weakness and endurance could yield important lessons, because such issues can require a different kind of a care including “post-hospitalization rehabilitation opportunities.”In fact, Dr. Penner said, the team at Great Ormond Street Hospital has made changes in the treatment of children hospitalized with the syndrome since the fall, because it has recognized “how affected their muscles are at the onset and how profoundly fatigued and weakened these kids are.”In the hospital, for example, “often just transferring from the bed to the toilet is exceptionally difficult for these children,” he said.The hospital now has a more concerted focus on providing the children in-hospital physical therapy and work with musculoskeletal therapists, he said, and it sends them home with an individualized rehabilitation plan that is linked to an app.“We’ve also involved our occupational therapists, and we’ve developed a fatigue program that’s run once a month where the parents dial in for a group session,” Dr. Penner said. “I think the main message that we give them is to avoid this boom-and-bust cycle, where the kids try to do the things they used to do at full speed and then they kind of crash afterwards — as opposed to a gradual increase of activity back to their normal state.”The hospital’s team is continuing to follow the children’s health. One potential concern is whether kidney or gastrointestinal problems might emerge later, which can occur after other critical illnesses, the study’s authors wrote. The team also hopes to conduct neurocognitive evaluations and other neurological testing, Dr. Penner said.“We don’t know what the longer-term outcomes will be,” Dr. Penner said. But for now, he added, “being able to relay at least what we’ve seen so far to parents has really enabled us to alleviate some of their anxieties about this black box of unknowns with regard to this new condition.”

A small study found that six months after hospitalization, most children with MIS-C did not have debilitating health issues. But some had lingering muscle weakness and emotional difficulties.Children who get sick from the rare but serious Covid-related inflammatory syndrome may surmount their most significant symptoms within six months, but they may still have muscle weakness and emotional difficulties at that time, a new small study suggests.Published in the journal Lancet Child and Adolescent Health on Monday, the study appears to be the first detailed look at the health status of children six months after they were hospitalized with the condition, called Multisystem Inflammatory Syndrome in Children. The syndrome typically emerges two weeks to six weeks after a Covid-19 infection that is often quite mild, and it can result in hospitalizations for children with severe symptoms involving the heart and several other organs.A major question has been whether children who survive MIS-C will end up with lasting organ damage or other health problems. The new study, of 46 children under 18 who were admitted to a London hospital for MIS-C (it has a different name and abbreviation, PIMS-TS, in Britain), suggests that many of the most serious problems can resolve with time.“To be honest, I think we all didn’t know what to expect,” said Dr. Justin Penner, a pediatric infectious disease physician at the hospital involved in the study, Great Ormond Street Hospital, known as GOSH. “We didn’t know which body systems would require assistance or become a problem one month, three months, six months down the line.”The children in the study were hospitalized between April 4 and Sept. 1, 2020, part of the first wave of the inflammatory syndrome. Many were quite sick. They all had systemic inflammation, and most had symptoms involving multiple organ systems, such as the heart, kidneys or circulatory system. Forty-five children had gastrointestinal symptoms, and 24 had neurological symptoms such as confusion, memory problems, hallucinations, headaches or problems with balance or muscle control.Sixteen of the children were placed on ventilators, 22 needed medication to help their hearts pump more effectively and 40 were treated with immunotherapies like intravenous immunoglobulin. All survived.Six months after they were discharged from the hospital, only one child still had systemic inflammation, just two children had heart abnormalities and six children had gastrointestinal symptoms. All but one child was able to resume school, either virtually or in person.Still, 18 of the children were experiencing muscle weakness and fatigue, scoring in the bottom 3 percent for their age and sex on the six-minute walking test, a standard test of endurance and aerobic capacity. And 15 children were experiencing emotional difficulties like anxiety or severe mood changes, according to questionnaires answered by either the parents or the children.In the United States, 3,742 young people age 20 and under have developed the syndrome, and 35 have died, according to the most recent data from the Centers for Disease Control and Prevention. A major study of long-term outcomes has already recruited 600 children and will follow them for five years, according to a leader of that effort, Dr. Jane Newburger, associate chief for academic affairs in the cardiology department at Boston Children’s Hospital.Dr. Newburger, who was not involved in the British report, called it a “small but important study” that “contributes new information to the knowledge gap about long-term effects of MIS-C.”She and the authors themselves noted that there were limitations to the findings because the children in the study were not compared with a control group of children without MIS-C or those with other illnesses. It is unclear, for example, if their emotional problems and muscle weakness were the result of the syndrome, the process of being hospitalized for an illness or other stressors during this time. “Mental health and physical conditioning have taken a hit in children and adolescents in general during the pandemic,” Dr. Newburger said.Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, who was not involved in the new study, said it might be difficult to tease out which residual problems were directly attributable to the syndrome and which might have resulted from any critical illness. He said the fact that some of the children still had trouble with muscle weakness and endurance could yield important lessons, because such issues can require a different kind of a care including “post-hospitalization rehabilitation opportunities.”In fact, Dr. Penner said, the team at Great Ormond Street Hospital has made changes in the treatment of children hospitalized with the syndrome since the fall, because it has recognized “how affected their muscles are at the onset and how profoundly fatigued and weakened these kids are.”In the hospital, for example, “often just transferring from the bed to the toilet is exceptionally difficult for these children,” he said.The hospital now has a more concerted focus on providing the children in-hospital physical therapy and work with musculoskeletal therapists, he said, and it sends them home with an individualized rehabilitation plan that is linked to an app.“We’ve also involved our occupational therapists, and we’ve developed a fatigue program that’s run once a month where the parents dial in for a group session,” Dr. Penner said. “I think the main message that we give them is to avoid this boom-and-bust cycle, where the kids try to do the things they used to do at full speed and then they kind of crash afterwards — as opposed to a gradual increase of activity back to their normal state.”The hospital’s team is continuing to follow the children’s health. One potential concern is whether kidney or gastrointestinal problems might emerge later, which can occur after other critical illnesses, the study’s authors wrote. The team also hopes to conduct neurocognitive evaluations and other neurological testing, Dr. Penner said.“We don’t know what the longer-term outcomes will be,” Dr. Penner said. But for now, he added, “being able to relay at least what we’ve seen so far to parents has really enabled us to alleviate some of their anxieties about this black box of unknowns with regard to this new condition.”

El síndrome MIS-C puede afectar a los menores semanas después de infectarse con el coronavirus. Los expertos, tras publicarse el mayor estudio realizado en Estados Unidos sobre la afección, recomiendan a los pediatras estar atentos.Muchos niños y adolescentes que desarrollaron el misterioso síndrome inflamatorio que puede manifestarse varias semanas después de contraer el coronavirus nunca tuvieron los síntomas clásicos de COVID-19 al momento de su infección, según el estudio de casos más grande hasta ahora en Estados Unidos.El estudio, dirigido por investigadores de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés), encontró que en más de 1000 casos en los que se disponía de información sobre si se habían enfermado por su COVID-19 inicial, el 75 por ciento de los pacientes no experimentaron tales síntomas. Sin embargo, de dos a cinco semanas después, se enfermaron lo suficiente como para ser hospitalizados por la afección, llamada síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés), que puede afectar diversos órganos, especialmente el corazón.El estudio, publicado el 6 de abril en JAMA Pediatrics, afirmó que “se cree que la mayoría de las enfermedades MIS-C son el resultado de casos leves o asintomáticos de COVID-19” seguidos de una respuesta hiperinflamatoria que parece ocurrir cuando los cuerpos de los pacientes han producido su nivel máximo de anticuerpos contra el virus. Los expertos aún no saben por qué algunos jóvenes, y una cantidad menor de adultos, responden de esta manera.“Eso significa que los pediatras de atención primaria deben tener un alto índice de sospecha de esto porque la covid es muy frecuente en la sociedad y los niños a menudo tienen una enfermedad asintomática en su infección inicial de covid”, afirmó Jennifer Blumenthal, intensivista pediátrica y especialista en enfermedades infecciosas pediátricas del Hospital para Niños de Boston, quien no estuvo involucrada en el estudio.Los investigadores evaluaron 1733 de los 2090 casos del síndrome en personas de 20 años o menos que habían sido reportados a los CDC hasta enero.Los resultados muestran que, aunque el síndrome es poco común, puede ser grave. Los datos de los CDC solo incluyeron pacientes que fueron hospitalizados. Más del 90 por ciento de estas personas jóvenes experimentaron síntomas que involucraron al menos cuatro sistemas de órganos y el 58 por ciento necesitó tratamiento en unidades de cuidados intensivos.Muchos experimentaron problemas cardiacos importantes: más de la mitad desarrolló baja presión arterial, el 37 por ciento desarrolló choque cardiogénico y el 31 por ciento experimentó una disfunción cardiaca relacionada con la incapacidad del corazón para bombear de forma adecuada. El estudio afirmó que un porcentaje significativamente mayor de pacientes que no habían tenido síntomas de COVID-19 experimentaron estos problemas cardiacos, en comparación con aquellos que sí tuvieron síntomas iniciales de coronavirus. Un porcentaje mayor de pacientes que al principio fueron asintomáticos también terminaron en unidades de cuidados intensivos (UCI).“Incluso la gran mayoría de los niños con casos graves de MIS-C que estuvieron en la UCI, no tuvieron una enfermedad previa que pudieran reconocer”, afirmó Roberta DeBiasi, jefa del departamento de enfermedades infecciosas del Children’s National Hospital en Washington D. C., quien no participó en la investigación.El estudio proporcionó la imagen demográfica y geográfica más detallada del síndrome hasta la fecha. Alrededor del 34 por ciento de los pacientes eran negros y el 37 por ciento eran hispanos, lo que refleja la forma en que el coronavirus ha afectado desproporcionadamente a los miembros de esas comunidades. A medida que avanzaba la pandemia, escribieron los autores, aumentó la proporción de pacientes de raza blanca, que representaban el 20 por ciento de todos los casos. Las personas de origen asiático representaban poco más del uno por ciento de los pacientes.En general, casi el 58 por ciento de los pacientes eran hombres, pero la proporción no era la misma en todas las edades. En el grupo más joven —recién nacidos hasta los 4 años— el número de niños y niñas era prácticamente igual, y la proporción entre hombres y mujeres aumentaba en los grupos de mayor edad hasta que la proporción llegaba a más de dos en el grupo de 18 a 20 años.La gran mayoría de los pacientes (casi el 86 por ciento) eran menores de 15 años. El estudio reveló que los menores de 5 años tuvieron el menor riesgo de desarrollar complicaciones cardiacas graves y fueron menos propensos a necesitar cuidados intensivos. Los pacientes de 10 años o más tuvieron una probabilidad mucho mayor de desarrollar problemas como choque cardiogénico, presión arterial baja y miocarditis (inflamación del músculo cardiaco).“Creo que es parecido a lo que vimos con la covid, donde los niños mayores parecían tener enfermedades más graves”, dijo DeBiasi. “Y eso se debe a que lo que en realidad enferma a las personas de la covid es su aspecto inflamatorio, así que quizás estos niños mayores, por diversas razones, produjeron más inflamación en la covid inicial o en el MIS-C”.Aun así, un número significativo de los pacientes más jóvenes desarrollaron problemas cardiacos. En el grupo entre recién nacidos hasta niños de 4 años, el 36 por ciento tuvo baja presión arterial, 25 por ciento tuvo choque cardiogénico y el 44 por ciento recibió tratamiento en la UCI.Pacientes de todas las edades en el estudio experimentaron casi la misma incidencia de algunos de los problemas cardiacos menos comunes relacionados con el síndrome, como aneurismas coronarios y acumulación de líquido. Los niños de 14 años o menos fueron más propensos a tener sarpullido y enrojecimiento de los ojos, mientras que los mayores de 14 tuvieron mayores probabilidades de desarrollar dolor en el pecho, dificultad para respirar y tos. Cerca de dos tercios de todos los pacientes se vieron afectados por dolores abdominales y vómito.Se registraron 24 muertes, repartidas en todos los grupos de edad. No hubo información en el estudio sobre si los pacientes tenían afecciones médicas subyacentes, pero los médicos e investigadores informaron que las personas jóvenes con MIS-C por lo general estuvieron previamente sanas y tenían muchas más probabilidades de estar sanas que el número relativamente pequeño de jóvenes que padecieron enfermedades graves de las infecciones iniciales de covid.De los 1075 pacientes de los que se tenía información sobre la enfermedad de covid inicial, solo 265 mostraron síntomas en ese momento. Eran más propensos a ser mayores: su edad promedio fue de 11 años, mientras que la edad promedio de aquellos con infecciones de covid asintomáticas fue de 8. Sin embargo, eso podría deberse a que “los niños más pequeños no pueden expresar sus preocupaciones con la misma eficiencia”, aseguró Blumenthal, quien coescribió una editorial sobre el estudio.“En realidad no sabemos si en efecto hay menos sintomatología en la población muy joven”, concluyó.Tampoco están claras las razones que subyacen al hallazgo del estudio de que en la primera oleada de MIS-C, del 1 de marzo al 1 de julio de 2020, los jóvenes eran más propensos a algunas de las complicaciones cardíacas más graves. DeBiasi dijo que eso no coincidía con la experiencia de su hospital, donde “los niños estaban más enfermos en la segunda ola”.El estudio documentó dos oleadas de casos de MIS-C que siguieron a los aumentos de los casos generales de coronavirus durante un mes o más. “El tercer pico más reciente de la pandemia de COVID-19 parece estar conduciendo a otro pico de MIS-C que quizá implique a comunidades urbanas y rurales”, escribieron los autores.El estudio descubrió que la mayoría de los estados en los que la tasa de casos de MIS-C por población era más alta se encontraban en el noreste, donde se produjo el primer aumento de casos, y en el sur. Por el contrario, la mayoría de los estados con altas tasas de niños con COVID-19 por población, pero con bajas tasas de MIS-C, se encontraban en el Medio Oeste y el Oeste. Aunque la concentración de casos se extendió de las grandes ciudades a los pueblos más pequeños con el tiempo, no fue tan pronunciada como las tendencias generales de la pandemia, dijeron los autores.Blumenthal dijo que ese patrón geográfico podría reflejar que la “comprensión de las complicaciones de la enfermedad” no había alcanzado su prevalencia en las distintas regiones o que muchos estados con tasas más bajas de MIS-C tienen poblaciones menos diversas étnicamente. “También podría tratarse de algo relacionado con la propia covid, aunque no lo sabemos”, dijo. “En este momento, no sabemos nada sobre cómo las variantes afectan necesariamente a los niños”.El estudio representó solo los criterios más estrictos sobre MIS-C, al excluir unos 350 casos notificados que cumplían la definición del síndrome de los CDC pero tenían una prueba de anticuerpos negativa o presentaban principalmente síntomas respiratorios. DeBiasi dijo que también hay muchos casos probables de MIS-C que no se comunican a los CDC porque no cumplen todos los criterios oficiales.“Estos probables niños con MIS-C, en la vida real, son un montón de niños”, dijo. Además, aunque hasta ahora se ha centrado en los casos graves, “hay todo un grupo de niños que en realidad pueden tener MIS-C leve”.Si una comunidad ha experimentado un aumento reciente de coronavirus, entonces “solo porque el niño diga: ‘Nunca he tenido covid o mis padres nunca lo han tenido’, eso no significa que el niño que tienes delante no tenga MIS-C”, dijo DeBiasi. “Si tu ciudad tiene covid, prepárate”.Pam Belluck es una reportera de ciencia y salud cuyos galardones incluyen un Premio Pulitzer compartido en 2015 y el premio Nellie Bly a la mejor historia de primera plana. Es autora de Island Practice, un libro sobre un doctor peculiar. @PamBelluck

“I can’t do this anymore,” Sonia Sein told herself, her family and her doctor.For six years, she had endured a tube inserted in her windpipe, or trachea, to keep her alive, but her discomfort and distress were becoming more and more unbearable.Largely confined to her Bronx apartment, she needed home health aides and had to quit her career as a social worker for pregnant women. If she talked for over five minutes, she had to stop “because I couldn’t breathe.”The tube was necessary because her trachea — the airway leading to the lungs — had become damaged after she spent weeks on a ventilator for a severe asthma attack in 2014. She had subsequently undergone six major surgeries and more than 10 smaller procedures, but with all conventional approaches to address her condition exhausted, she made plans to have the tube removed and receive only palliative care. “I don’t want to live like this,” she concluded.Today, Ms. Sein, 56, dances and plays tag with her grandchildren and plans to resume working, possibly as an acupuncturist. She says she feels she has been given a “chance of being alive one more time.”Her transformation follows a groundbreaking experimental procedure she underwent in January: the first time, medical experts believe, a donor trachea has been successfully directly transplanted into another person.The 18-hour procedure, conceived and led by Dr. Eric M. Genden Sr., chairman of otolaryngology-head and neck surgery at Mount Sinai Health System in New York, is a milestone because — unlike kidneys, hearts and lungs — the trachea has defied decades of transplantation attempts.“It’s very exciting,” said Dr. G. Alexander Patterson, a professor of surgery at Washington University in St. Louis, who was not involved in the case.Thousands of people in the United States alone develop trachea problems each year from burns, birth defects, tumors and extended intubation on ventilators. The coronavirus pandemic will most likely create more cases because many Covid-19 patients have needed weeks on ventilators.Hundreds of Americans are estimated to die each year because techniques like stents, surgery or lasers cannot heal their damaged tracheas, and they suffocate when airways narrow dangerously or collapse.“There was nothing anybody could do for these patients,” said Dr. Genden, who became captivated by the problem in medical school 30 years ago after a patient with a tracheal tumor died. Guided by several mentors, he delved into research and animal experiments, developing a transplant approach.Because immunosuppressant drugs are required to prevent rejection of the transplant, cancer patients would be eligible only if free of cancer for five years, Dr. Genden said. For other cases, though, doctors say the approach seems promising.“It’s very significant,” said Dr. Pierre Delaere, a professor of head and neck surgery at University Hospital Gasthuisberg in Belgium, a trachea specialist not involved in the case. Still, noting that previous attempts didn’t show documented success, he cautioned that longer-term results were needed before the technique should be embraced, adding, “Let’s see how it works and how you can do it in more patients.”The apparent success of Ms. Sein’s operation is also notable because the trachea field has been rocked for years by a sensational scandal.Ms. Sein speaking with Dr. Eric M. Genden Sr., left, who developed the pioneering procedure, and Dr. Sander S. Florman, director of Mount Sinai’s Transplantation Institute.Sarah Blesener for The New York TimesThat drama began about a decade ago when Dr. Paolo Macchiarini, working at Sweden’s famed Karolinska Institute, garnered headlines and accolades for replacing damaged tracheas with plastic tubes seeded with patients’ stem cells that he cultivated in devices called bioreactors. The transplants, performed on patients from the United States and other countries, were heralded as inaugurating a regenerative medicine revolution.But of 20 patients, including children, most ultimately died, and scientists said Dr. Macchiarini misrepresented data and exaggerated his technique’s effectiveness.A Swedish filmmaker’s investigative documentary raised further questions, as did a Vanity Fair article detailing how the beguiling surgeon became romantically involved with an NBC producer working on a feature about him and apparently conned her into believing he was divorced and would marry her in a ceremony officiated by the pope and attended by the Clintons, Obamas, John Legend and Elton John.The Karolinska Institute, alleging scientific misconduct, dismissed Dr. Macchiarini, who has long denied wrongdoing. Journals retracted several of his studies. In 2019, an Italian court said he had forged documents and abused his position, charges unrelated to his trachea work. In September, a Swedish prosecutor indicted him on aggravated assault charges related to three trachea transplants. The case is pending.Dr. Genden said Dr. Macchiarini’s rise and fall profoundly affected his own path.“Here’s this handsome Italian surgeon at the finest institution in the world, the Karolinska, and he’s everything I’m not: He’s got a beautiful head of hair, he drives a motorcycle, he’s got an accent, he’s incredibly charismatic and dynamic,” Dr. Genden said. “He says, ‘I’ve created this bioreactor and it’s stem cells and it makes tracheas.’ And it’s huge.”Dr. Genden said that when he and colleagues questioned Dr. Macchiarini at a conference early on, “in his bigger-than-life way he says, ‘This is ridiculous, you don’t know what you’re talking about, it functions beautifully.’”Dr. Genden thought his work had “become obsolete, so you basically shut down the lab,” he said. “You can’t justify doing experimental surgery and immunosuppression when you see something else that looks perfect, so you realize, wow, we’re out of business.”As Dr. Macchiarini’s work drew criticism, Dr. Genden revived his idea, but was uncertain about trying it. The scandal meant “there’s an amazing amount of scrutiny,” he said. “We’re going to show up and say, ‘As a student, I had this idea on the back of a napkin and now we’re ready to go’ — and if it fails, the patient dies and it becomes yet another example of some surgeon who thought he could solve a problem and he’s created, instead, just the opposite.”There was another reason to be daunted too: historical assumptions that tracheas weren’t transplantable.“The trachea has been characterized as a simple tube, but it’s very complex,” Dr. Delaere said. About 11 centimeters (4⅓ inches) long, one side curves like a halfpipe, composed of cartilage rings and ligaments. The other side is flat and mobile to move air to the lungs.Video by Mount Sinai HospitalAny replacement trachea must be rigid or “it’ll collapse like a straw in a McDonald’s milkshake,” Dr. Genden said. It must be lined with cilia, hairlike projections “like shag carpeting” that move and clean the air we breathe in, he said. And it needs a blood supply to connect to the patient’s vascular system.Other trachea replacement attempts include transplanting part of a donor’s frozen, preserved aorta, the body’s main artery, and fabricating tracheas from patients’ own chest muscles and rib cartilage.“Some of them have been successful, but they’re cumbersome in different ways and they’re not a trachea,” Dr. Patterson said. “It’s kind of a marginal substitute, and many patients need further interventions to maintain their airways.”Dr. Delaere developed another innovative method, performed on nine patients so far: implanting a section of donor trachea in a patient’s forearm for weeks until it develops blood vessels and can replace part of the patient’s trachea. An advantage is that immunosuppressants are necessary only for several months, he said.But, he added, “It’s an indirect technique.” It takes time and can replace only the trachea’s halfpipe side, “so it’s not a complete tube.”Dr. Genden said some scientists told him “‘You’re out of your mind’” because trying a transplant would risk his reputation. But when Dr. Sander S. Florman, director of Mount Sinai’s Transplantation Institute, and LiveOnNY, a nonprofit organ donation organization, agreed to collaborate, his wife, Audrey, encouraged him.“My wife was the one who said, ‘If you truly believe that people are dying from this and that you could maybe make a difference, you can’t just fold up and go home,’” he said.The “secret sauce” in his approach, he said, is transplanting not just the donor trachea but also its attached esophagus (food tube), thyroid gland and thyroid arteries. That meant the donor trachea was accompanied by a blood supply that Dr. Genden connected to Ms. Sein’s blood vessels.Guided by a high-powered microscope, he used surgical thread half the diameter of a human hair. He opened and cleaned out the donor’s esophagus, laying it against Ms. Sein’s esophagus.“That was a very smart idea to help maintain the fragile blood supply of the airway by leaving the esophagus in place behind it,” Dr. Patterson said.Dr. Genden also transplanted the cricoid, cartilage cuffing the trachea, supplanting Ms. Sein’s completely destroyed cricoid. The nine-centimeter transplant replaced all but two centimeters of her trachea.The donor was a young man (identifying details are being withheld to protect privacy). The different gender was important, allowing Dr. Genden to use chromosomal analysis to detect whether Ms. Sein’s cells populated the new trachea. As of late March, 6.5 percent of cells in the donor trachea were hers, with the proportion increasing, he said.He hopes the immunosuppressant drugs, which can create health risks, can be reduced or even stopped “if the entire graft becomes filled with Sonia’s cells.”Ms. Sein’s trachea before, left, and her new transplanted trachea.Mount SinaiFor Ms. Sein, the procedure was a long-sought dream. In 2017, after another hospital said everything possible had been tried, she felt desperate.“I thought, ‘If they do a transplant for everything, they should do a transplant for trachea,’” she recalled. “I Googled ‘trachea transplant’ and Dr. Genden popped up. So I called and called till I got an appointment.”Dr. Genden said Ms. Sein beseeched him for the transplant, saying, “‘You need to do this for me or I’m going to end my life.’”After realizing other treatment methods wouldn’t help, he concluded that Ms. Sein had a “logical, thoughtful” grasp of transplantation’s risks and of her health condition. He understood how difficult her life had become.At night, when she connected her tracheal tube to a ventilator, “the alarm kept going off to let people know that I stopped breathing,” said Ms. Sein, who hated causing her family concern.Because mucus would clog her tube, “she was constantly suctioning, constantly worried about her airway, and it becomes overwhelming,” Dr. Genden said, like being held down in a swimming pool. “You start to panic because you can’t breathe.”By early 2020, ethical approvals were in place, but the coronavirus pandemic held things up. By this year, Dr. Genden said, her condition had deteriorated so that “if we delay further, it’s not going to work out.”On Jan. 12, Dr. Genden got a call: An appropriate donor had died. The next morning, with the donor and Ms. Sein in adjacent rooms, a team of over 50 medical personnel assembled.“I had a brave face, but I was scared,” Ms. Sein said. She considered backing out.“You got this?” she asked Dr. Genden.“He said ‘yeah,’ so I said ‘Let’s go for it.’”After extracting the donor’s organs, “you go next door and you open up Sonia and you remove the diseased trachea, and there is no going back,” Dr. Genden said. “It’s like when you get on a rocket ship.”At times, he felt “in a dreamlike state,” he said. When the blood vessels were finally connected, the donor trachea began bleeding. “This thing came to life,” Dr. Genden marveled, “and we were like, ‘Holy smokes, we’ve done it.’”Photographs document Ms. Sein’s trachea transformation: Her old windpipe looks raw and red, her new one smooth as porcelain.“I can breathe,” she was amazed to discover. “I could feel it in my lungs.”After several weeks in recovery, she is home. She visits Mount Sinai weekly for blood work. Dr. Genden examines the new trachea by inserting a scope in a hole he left in her neck, which he’ll eventually close.Recently, Ms. Sein, covering the hole with her hand to speak, enthused about having the energy to cook sesame chicken for the first time and how she aims to visit relatives in Puerto Rico. Next month, she will turn 57.“We would have been planning my funeral,” she said, “but now we’re planning a birthday party.”

In the fall, after Samar Khan came down with a mild case of Covid-19, she expected to recover and return to her previous energetic life in Chicago. After all, she was just 25, and healthy.But weeks later, she said, “this weird constellation of symptoms began to set in.”She had blurred vision encircled with strange halos. She had ringing in her ears, and everything began to smell like cigarettes or Lysol. One leg started to tingle, and her hands would tremble while putting on eyeliner.She also developed “really intense brain fog,” she said. Trying to concentrate on a call for her job in financial services, she felt as if she had just come out of anesthesia. And during a debate about politics with her husband, Zayd Hayani, “I didn’t remember what I was trying to say or what my stance was,” she said.By the end of the year, Ms. Khan was referred to a special clinic for Covid-related neurological symptoms at Northwestern Memorial Hospital in Chicago, which has been evaluating and counseling hundreds of people from across the country who are experiencing similar problems.Now, the clinic, which sees about 60 new patients a month, in-person and via telemedicine, has published the first study focused on long-term neurological symptoms in people who were never physically sick enough from Covid-19 to need hospitalization, including Ms. Khan.The study of 100 patients from 21 states, published on Tuesday in The Annals of Clinical and Translational Neurology, found that 85 percent of them experienced four or more neurological issues like brain fog, headaches, tingling, muscle pain and dizziness.“We are seeing people who are really highly, highly functional individuals, used to multitasking all the time and being on top of their game, but, all of a sudden, it’s really a struggle for them,” said Dr. Igor J. Koralnik, the chief of neuro-infectious diseases and global neurology at Northwestern Medicine, who oversees the clinic and is the senior author of the study.The report, in which the average patient age was 43, underscores the emerging understanding that for many people, long Covid can be worse than their initial bouts with the infection, with a stubborn and complex array of symptoms.This month, a study that analyzed electronic medical records in California found that nearly a third of the people struggling with long Covid symptoms — like shortness of breath, cough and abdominal pain — did not have any signs of illness in the first 10 days after they tested positive for the coronavirus. Surveys by patient-led groups have also found that many Covid survivors with long-term symptoms were never hospitalized for the disease.In the Northwestern study, many experienced symptoms that fluctuated or persisted for months. Most improved over time, but there was wide variation. “Some people after two months are 95 percent recovered, while some people after nine months are only 10 percent recovered,” said Dr. Koralnik. Five months after contracting the virus, patients estimated, they felt on average only 64 percent recovered.

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.Tim Gruber for The New York TimesOne 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 TimesScientists 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 TimesBridget 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.”

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.Tim Gruber for The New York TimesOne 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 TimesScientists 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 TimesBridget 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.”

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storyMany ‘Long Covid’ Patients Had No Symptoms From Their Initial InfectionAn analysis of electronic medical records in California found that 32 percent started with asymptomatic infections but reported troubling aftereffects weeks and months later.The study of 1,407 people who tested positive for coronavirus found more than 30 symptoms, including anxiety, low back pain, fatigue, insomnia, gastrointestinal problems and rapid heart rate.Credit…Pete Kiehart for The New York TimesMarch 8, 2021, 6:52 p.m. ETMany people who experience long-term symptoms from the coronavirus did not feel sick at all when they were initially infected, according to a new study that adds compelling information to the increasingly important issue of the lasting health impact of Covid-19.The study, one of the first to focus exclusively on people who never needed to be hospitalized when they were infected, analyzed electronic medical records of 1,407 people in California who tested positive for the coronavirus. More than 60 days after their infection, 27 percent, or 382 people, were struggling with post-Covid symptoms like shortness of breath, chest pain, cough or abdominal pain.Nearly a third of the patients with such long-term problems had not had any symptoms from their initial coronavirus infection through the 10 days after they tested positive, the researchers found.Understanding long-term Covid symptoms is an increasingly pressing priority for doctors and researchers as more and more people report debilitating or painful aftereffects that hamper their ability to work or function the way they did before. Last month, the director of the National Institutes of Health, Dr. Francis S. Collins, announced a major initiative “to identify the causes and ultimately the means of prevention and treatment of individuals who have been sickened by Covid-19, but don’t recover fully over a period of a few weeks.”David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City, who was not involved in the new research, said that he and his colleagues at Mount Sinai’s center for post-Covid care are seeing a similar pattern.“Many people who had asymptomatic Covid can also go on to develop post-acute Covid syndrome,” said Dr. Putrino, who is a co-author of a smaller study on the topic published last year. “It doesn’t always match up with severity of acute symptoms, so you can have no symptoms but still have a very aggressive immune response.”The new study is published on the preprint site MedRxiv and has not finished undergoing peer review. Its strengths include that it is larger than many studies on long-term symptoms published so far and that the researchers used electronic records from the University of California system, allowing them to obtain health and demographic information of patients from throughout the state. The researchers also excluded from the study symptoms that patients had reported in the year before their infection, a step intended to ensure a focus on post-Covid symptoms.Among their findings: Long-term problems affect every age group, including children. “Of the 34 children in the study, 11 were long-haulers,” said one of the authors, Melissa Pinto, an associate professor of nursing at the University of California Irvine.The study found more than 30 symptoms, including anxiety, low back pain, fatigue, insomnia, gastrointestinal problems and rapid heart rate. The researchers identified five clusters of symptoms that seemed most likely to occur together, like chest pain and cough or abdominal pain and headache.Most previous studies of long-term symptoms have tended to involve people who were sick enough from their initial infection to be hospitalized. One of the largest found that more than three-quarters of about 1,700 hospitalized patients in Wuhan, China, had at least one symptom six months later.The Coronavirus Outbreak