The U.S. needs a nimble, multipronged strategy and Cabinet-level leadership to counter its festering overdose epidemic, a bipartisan congressional commission advises.

With vastly powerful synthetic drugs like fentanyl driving record overdose deaths, the scourge of opioids awaits after the COVID-19 pandemic finally recedes, a shift that public health experts expect in the months ahead.

“This is one of our most pressing national security, law enforcement and public health challenges, and we must do more as a nation and a government to protect our most precious resource — American lives,” the Commission on Combating Synthetic Opioid Trafficking said in a 70-page report released Tuesday to Congress, President Joe Biden and the American people.

The report envisions a dynamic strategy. It would rely on law enforcement and diplomacy to shut down sources of chemicals used to make synthetic opioids. It would offer treatment and support for people who become addicted, creating pathways that can lead back to productive lives. And it would invest in research to better understand addiction’s grip on the human brain and to develop treatments for opioid use disorder.

The global coronavirus pandemic has overshadowed the American opioid epidemic for the last two years, but recent news that overdose deaths surpassed 100,000 in one year caught the public’s attention. Politically, federal legislation to address the opioid crisis won support across the partisan divide during both the Obama and Trump administrations.

Rep. David Trone, D-Md., a co-chair of the panel that produced the report, said he believes that support is still there, and that the issue appeals to Biden’s pragmatic side. “The president has been crystal clear,” Trone said. “These are two major issues in America: addiction and mental health.”

The U.S. government’s record is also clear. It has been waging a losing “war on drugs” for decades.

The stakes are much higher now with the widespread availability of fentanyl, a synthetic painkiller 80 to 100 times more powerful than morphine. It can be baked into illicit pills made to look like prescription painkillers or anti-anxiety medicines. The chemical raw materials are produced mainly in China. Criminal networks in Mexico control the production and shipment to the U.S.

Federal anti-drug strategy traditionally emphasized law enforcement and long prison sentences. But that came to be seen as tainted by racial bias and counter-productive because drug use is treatable. The value of treatment has recently has gained recognition with anti-addiction medicines in wide use alongside older strategies like support groups.

The report endorsed both law enforcement and treatment, working in sync with one another.

“Through its work, the commission came to recognize the impossibility of reducing the availability of illegal synthetic opioids through efforts focused on supply alone,” the report said.

“Real progress can come only by pairing illicit synthetic opioid supply disruption with decreasing the domestic U.S. demand for these drugs,” it added.

The report recommends what it calls five “pillars” for government action:

Elevating the White House Office of National Drug Control Policy to act as the nerve center for far-flung federal efforts, and restoring Cabinet rank to its director.
Disrupting the supply of drugs through better coordinated law enforcement actions.
Reducing the demand for illicit drugs through treatment and by efforts to mitigate the harm to people addicted. Treatment programs should follow science-based "best practices."
Using diplomacy to enlist help from other governments in cutting off the supply of chemicals that criminal networks use to manufacture fentanyl.
Developing surveillance and data analysis tools to spot new trends in illicit drug use before they morph into major problems for society.

Trone said it’s going to take cooperation from both political parties. “We have to take this toxic atmosphere in Washington and move past it,” he said. “Because 100,000 people, that’s husbands, sisters, mothers, fathers. As a country, we are better than that.”
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Paris — Plastic has infiltrated all parts of the ocean and is now found “in the smallest plankton up to the largest whale” wildlife group WWF said on Tuesday, calling for urgent efforts to create an international treaty on plastics.

Tiny fragments of plastic have reached even the most remote and seemingly pristine regions of the planet: it peppers Arctic sea ice and has been found inside fish in the deepest recesses of the ocean, the Mariana Trench.

There is no international agreement in place to address the problem, although delegates meeting in Nairobi for a United Nations environment meeting this month are expected to launch talks on a worldwide plastics treaty.

WWF sought to bolster the case for action in its latest report, which synthesizes more than 2,000 separate scientific studies on the impacts of plastic pollution on the oceans, biodiversity and marine ecosystems.

The report acknowledged that there is currently insufficient evidence to estimate the potential repercussions on humans.

But it found that the fossil-fuel derived substance “has reached every part of the ocean, from the sea surface to the deep ocean floor, from the poles to coastlines of the most remote islands and is detectable in the smallest plankton up to the largest whale.”

According to some estimates, between 19 and 23 million tons of plastic waste is washed into the world’s waterways every year, the WWF report said.

This is largely from single-use plastics, which still constitute more than 60% of marine pollution, although more and more countries are acting to ban their use.

“In many places (we are) reaching some kind of saturation point for marine ecosystems, where we’re approaching levels that pose a significant threat,” said Eirik Lindebjerg, Global Plastics Policy Manager at WWF.

In some places there is a risk of “ecosystem collapse,” he said.

Many people have seen images of seabirds choking on plastic straws or turtles wrapped in discarded fishing nets, but he said the danger is across the entire marine food web.

It “will affect not only the whale and the seal and the turtle, but huge fish stocks and the animals that depend on those,” he added.

In one 2021 study, 386 fish species were found to have ingested plastic, out of 555 tested.

Separate research, looking at the major commercially fished species, found up to 30% of cod in a sample caught in the North Sea had microplastics in their stomach.

Once in the water, the plastic begins to degrade, becoming smaller and smaller until it is a “nano plastic,” invisible to the naked eye.

So even if all plastic pollution stopped completely, the volume of microplastics in the oceans could still double by 2050.

But plastic production continues to rise, potentially doubling by 2040, according to projections cited by WWF, with ocean plastic pollution expected to triple during the same period.

Lindebjerg compares the situation to the climate crisis — and the concept of a “carbon budget,” that caps the maximum amount of CO2 that can be released into the atmosphere before a global warming cap is exceeded.

“There is actually a limit to how much plastic pollution our marine ecosystems can absorb,” he said.

Those limits have already been reached for microplastics in several parts of the world, according to WWF, particularly in the Mediterranean, the Yellow and East China Seas (between China, Taiwan and the Korean Peninsula) and in the Arctic sea ice.

“We need to treat it as a fixed system that doesn’t absorb plastic, and that’s why we need to go towards zero emissions, zero pollution as fast as possible,” said Lindebjerg.

WWF is calling for talks aimed at drawing up an international agreement on plastics at the U.N. environment meeting, from February 28 to March 2 in Nairobi.

It wants any treaty to lead to global standards of production and real “recyclability.”

Trying to clean up the oceans is “extremely difficult and extremely expensive,” Lindebjerg said, adding that it was better on all metrics not to pollute in the first place.
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Millions of people around the world enjoy a daily cup of coffee; however, their daily caffeine fix could be under threat because climate change is killing coffee plants, putting farmers’ livelihoods at risk.

Inside the vast, steamy greenhouses at the Royal Botanic Gardens at Kew in the leafy suburbs of west London, Aaron Davis leads the research into coffee.

“Arabica coffee, our preferred coffee, provides us with about 60% of the coffee that we drink globally. It’s a delicious coffee, it’s the one we love to drink. The other species is robusta coffee, which provides us with the other 40% of the coffee we drink – but that mainly goes into instant coffees and espresso mixes,” Davis explains.

The cultivation of arabica and robusta coffee beans accounts for millions of livelihoods across Africa, South America and Asia.

“These coffees have served us very well for many centuries, but under climate change they’re facing problems,” Davis says.

“Arabica is a cool tropical plant; it doesn’t like high temperatures. Robusta is a plant that likes even moist conditions; it likes high rainfall. And under climate change, rainfall patters are being modified, and it’s also experiencing problems. In some cases, yields are dramatically reduced because of increased temperatures or reduced rainfall. But in some cases, as we’ve seen in Ethiopia, you might get a complete harvest failure and death of the trees.”

The solution could be growing deep in the forests of West Africa. There are around 130 species of coffee plant – but not all taste good. In Sierra Leone, scientists from Kew helped to identify one candidate, stenophylla, growing in the wild.

“This is extremely heat tolerant. And is an interesting species because it matches arabica in terms of its superb taste,” Davis says.

Two other coffee species also show promise for commercial cultivation in a changing climate: liberica and eugenioides, which “has low yields and very small beans, but it has an amazing taste,” according to Davis.

Some believe the taste is far superior. At the 2021 World Barista Championship in Milan, Australia’s Hugh Kelly won third prize with his eugenioides espresso. Kelly recalled the first time he tasted it at a remote farm in Colombia. “It was a coffee like I’ve never tasted before; as I tasted it, it was unbelievably sweet … I knew that sweetness and gentle acidity were the bones for an incredible espresso,” Kelly told judges in Milan.

Researchers hope Kelly’s success could be the breakthrough moment for these relatively unknown beans.

The team at the Botanic Gardens is working with farmers in Africa on cultivating the new coffees commercially. Catherine Kiwuka of the Ugandan National Agricultural Research Organization, who oversees some of the projects, says challenges still lie ahead.

“What requirements do they need? How do we boost its productivity? Instead of it being dominated by only two species, we have the opportunity to tap into the value of other coffee species.”

It’s hoped that substantial volumes of liberica coffee will be exported from Uganda to Europe this year. Researchers hope it will provide a sustainable income for farmers – and an exciting new taste for coffee drinkers.
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Pope Francis on Sunday decried the genital mutilation of millions of girls and the trafficking of women for sex, including openly on city streets, so others can make money off of them. 

In remarks to the public in St. Peter’s Square, the pope noted that the day was dedicated worldwide to ending the ritual mutilation, and he told the crowd that some 3 million girls each year undergo the practice, “often in conditions very dangerous for the health.”

“This practice, unfortunately widespread in various regions of the world, humiliates the dignity of women and gravely attacks their physical integrity,” Francis said.

Female genital mutilation comprises all procedures that involve changing or injuring female genitalia for non-medical reasons and violates the human rights, health and the integrity of girls and women, the United Nations says in championing an end to the practice.

The practice can cause severe pain, shock, excessive bleeding, infections, and difficulty in passing urine, as well as consequences for sexual and reproductive health. While mainly concentrated in some 30 countries in Africa and the Middle East, it is also a problem for girls and women living elsewhere, including among immigrant populations.

According to U.N. figures, at least 200 million girls and women alive today have undergone the practice.

The pope also told the faithful that on Tuesday, there will be a day of prayer and reflection worldwide against human trafficking.

“This is a deep wound, inflicted by the shameful search of economic interests, without respect for the human person,” Francis said. “So many girls — we see them on the streets — who aren’t free, they are slaves of the traffickers, who send them to work, and, if they don’t bring back money, they beat them,” the pope said. “This is happening today in our cities.”

“In the face of these plagues on humanity, I express my sorrow and I exhort all those who have responsibility to act in a decisive way to impede both the exploitation and the humiliating practices that afflict in particular women and girls,” Francis said.
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New Zealand Prime Minister Jacinda Ardern said in an address on the nation’s Waitangi Day observance that the country has an obligation to make sure everyone has access to the health care they need, and that no one dies younger than everyone else in New Zealand because they are Maori.”

The commemorative day is named for the region on the North Island where representatives of the British Crown and more than 500 Indigenous Maori chiefs signed a founding treaty in 1840.

The Maori, however, lost most of their land during British colonization and have staged demonstrations on Waitangi Day to rally for their civil and social rights.

Last year New Zealand established the Maori Health Authority to ensure better health care access for the Maori who have been overwhelmed by COVID pandemic.

“We all have a duty to do everything we can to protect our communities with all the tools that science and medicine have given us,” Ardern said Sunday, as she called for a united battle against the coronavirus.

Turkey’s president is the latest world leader to reveal that he has contracted the coronavirus.

Recep Tayyip Erdogan revealed on Twitter Saturday that he and his wife, Emine, have been infected with the omicron variant of the COVID virus and are experiencing mild symptoms.

The news came just two days after the Turkish leader’s visit to Kyiv, where he met with Volodymyr Zelensky, his Ukrainian counterpart.

Two Miami men have each received a sentence of 41 months after stealing 192 ventilators worth approximately $3 million, according to a statement from the U.S. Attorney’s Office in the Southern District of Florida.

The U.S. Agency for International Development shipment was in a tractor trailer headed for Miami International Airport.  The shipment was stolen when the driver left the trailer on a parking lot overnight.

The ventilators “were part of an aid program to treat critically ill COVID-19 El Salvadorian patients,” according to the statement.  Most of the ventilators were recovered.

The Johns Hopkins Resource Center reported early Sunday that it has recorded more than 393 million global COVID infections and almost 6 million deaths. More than 10 billion vaccines have been administered, according to the center.

Some information in this report came from the Associated Press and Reuters.  

 
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In the two years since COVID-19 began ravaging the United States, virtually every aspect of the pandemic has been politicized, often to the detriment of efforts to bring the disease under control and to treat its victims. Now, though, members of Congress are taking the first steps toward a bipartisan effort to understand the pandemic’s origins and to assess the federal government’s response.

The two most senior members of the Senate Committee on Health, Education, Labor & Pensions have begun circulating a proposal to create a 12-member commission of private citizens with broad authority to investigate the origins of the disease – and how the Trump and Biden administrations responded to it. The initiative appears to have broad support among members of both parties.

The two lawmakers, Health Committee Chair Patty Murray, a Democrat from Washington, and the committee’s senior Republican, Richard Burr of North Carolina, have modeled the effort on the commission that was created to investigate the origins of the 9/11 terrorist attacks of 2001. That body won bipartisan praise for its exhaustive analysis of the events leading up to the attacks.

The proposal is part of a larger piece of legislation called the “Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act,” or the “PREVENT Pandemics Act,” for short. In addition to creating the task force, the bill would expand the capacity of public health agencies to respond to disease outbreaks, boost research and development, and strengthen the supply chain for medical products.

National task force

The panel proposed in the bill would be known as the “National Task Force on the Response of the United States to the COVID-19 Pandemic,” and would have the authority to issue subpoenas to compel testimony and the disclosure of records as necessary for the investigation.

Kristin Urquiza, one of the co-founders of an advocacy group for families affected by the pandemic known as Marked by COVID, told VOA she was encouraged by Murray and Burr’s proposal, calling it the best version of a framework for an investigative panel she has seen so far.

“Marked by COVID has been calling for a commission or a task force for well over a year,” Urquiza said. “It’s a top priority for our families to really ensure that we have an accurate record of what happened and why. Not only so we can have answers as to why our loved ones were lost, but so we can pass on learnings to ourselves and future generations for any mistakes that were made, and so that we can do better next time that there’s a public health crisis.”

Political minefield

So far, discussion of the pandemic’s origins and the federal response have tended to be highly politicized. In the earliest days of the pandemic, then-President Donald Trump was eager to downplay the severity of the crisis, a stance many of his political supporters adopted.

This helped create a sharp divide in how Republicans and Democrats across the country viewed the federal response to the pandemic.

As COVID-19 deaths in America grew from the thousands to the tens of thousands, Trump made a very public effort to blame China, the country where the disease was first identified, for the global health crisis. Arguments over the degree of China’s responsibility for the spread of the virus have also taken on a sharply partisan tone.

Efforts to blame China

Many Republicans in Congress have thrown their support behind the theory that the virus that causes COVID-19 escaped from a laboratory in China, where the coronavirus was being studied. This theory is supported by the fact that there is a major infectious disease research facility located near the city of Wuhan, where the virus was first detected.

Democrats, on the whole, have been more inclined to back the view put forward by the World Health Organization (WHO), which suggested that the virus migrated into the human population through close contact with wild animals – probably bats – that were already infected with a version of it.

The WHO, however, has sent mixed signals about the origins of the virus. A report issued by the body last year argued that it was extremely unlikely that the virus reached the human population through a laboratory leak. However, Dr. Tedros Adhanom Ghebreyesus, WHO director, said that China refused to share important data from early cases of COVID-19, hampering the ability of the WHO’s investigators to complete a thorough analysis.

In a series of congressional hearings, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and the chief medical adviser to President Biden, has been aggressively questioned by Republican members of Congress who have accused him of withholding information about research at the Wuhan institute of Virology that was partially funded by the U.S. government.

For his part, Fauci has publicly supported calls for an investigation into the origin of the virus.

Hope for a balanced inquiry

In the earlier stages of the pandemic, Republicans were suspicious of any commission tasked with investigating the pandemic, out of concern that its findings would be used as a cudgel against the Trump administration.

Urquiza, of Marked by COVID, said that the passage of time has made it less likely that the findings of a committee will be seen as politicized, because both parties can be seen as having some successes and some failures in the COVID-19 response.

“Our worry from day one was that a commission would turn into a witch hunt for either China or President Trump,” she said. “Part of what we’ve seen now, over the course of the last year, is that the Biden administration now has a pandemic track record, and that has opened up the field to allow for both praise and criticism of what has happened.” 

 

 
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The oceans got even warmer last year than the year before, supercharging already extreme weather patterns worldwide, according to a recent report published in the journal Advances in Atmospheric Sciences.

Twenty-three international scientists analyzed thousands of ocean temperature measurements. Since 2018, when the group first began publishing their findings, they have found that ocean temperatures are rising each year.

But the warming isn’t consistent around the planet.

In 2021, the researchers discovered that because of wind patterns and currents, some parts of the Atlantic, Indian and northern Pacific oceans warmed more quickly.

“The motion of water in the world’s oceans distributes the heat in a nonuniform way, so some areas get more heat and others less, meaning certain parts of the oceans warm faster than others,” said John Abraham, a co-author of the study and climate scientist at the University of St. Thomas in Minnesota.

Increasing concentrations of greenhouse gases from human activities are making the oceans too hot, Abraham told VOA.

“Last year, the oceans absorbed heat the equivalent of seven Hiroshima bombs being detonated in the ocean every second of every day, 365 days each year,” he said.

But even a slight rise in the temperature can be devastating.

“Last year, the surface temperatures of the oceans increased about 1 degree Celsius,” said Michael Mann, professor of atmospheric science at Pennsylvania State University and a contributor to the report. “And while that might sound like a small amount of warming, even modest changes in temperature can have a huge impact on the climate system, which can cause fish populations to decline and ice sheets to collapse in Antarctica.”

Only a small amount of heat from greenhouse gases actually gets trapped in the atmosphere. Most of it gets absorbed by the oceans.

“The oceans store 90% of global warming heat and are a robust indicator of climate change. Now, our oceans are warming at an exceptional rate that has serious consequences,” said Lijing Cheng, lead author of the study and an associate professor with the Institute of Atmospheric Physics at the Chinese Academy of Sciences.

“Sea level rise makes coastal communities more susceptible to storm surges that threaten coastal infrastructure,” Cheng told VOA.

Warming oceans are creating havoc on the Earth’s weather systems.

“The oceans drive the weather,” Abraham said. “Warmer oceans are making our weather wilder — going from one extreme to another more rapidly,” he said. “The oceans are heating and moistening the atmosphere, which is creating more intense storms.”

Tornadoes, hurricanes, floods and even snowstorms “are all connected to warming oceans,” said Alexey Mishonov, another co-author and an associate research scientist at the University of Maryland’s Earth System Science Interdisciplinary Center.

Mann said greenhouse gases need to be significantly curbed soon or the environmental consequences will become even worse.

“We’ve got to bring carbon emissions down by 50% within this decade,” he said. “We need governments to provide incentives to move the energy and transportation industries away from fossil fuels and towards renewable energy.” 

 

 
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The Philippines has suspended a heavily criticized policy banning the unvaccinated from public transportation in Metro Manila as a COVID-19 surge, caused by omicron variant, has subsided.

Daily cases in the Philippines rose from 400 in December to more than 39,000 in just a matter of days. The positivity rate, or percentage of positive cases out of those tested, peaked at more than 47%, as the country’s testing capacity remained low.

Hospitals were quickly overwhelmed after a brief holiday lull, but the Health Department said 85% of those admitted to intensive care units had not been vaccinated. Health care workers are exhausted, and many of those testing positive for the virus had to return to work immediately after recovering. Despite the record-breaking COVID-19 cases, the government did not impose a lockdown.

The Transportation Department implemented the “no vaccination, no ride” policy in Metro Manila, covering anyone taking public transportation starting Jan. 17, after President Rodrigo Duterte himself ordered the arrest of unvaccinated individuals who leave their homes.

Under the policy, unvaccinated or partially vaccinated individuals are barred from buses, jeepneys, trains and taxis, although unvaccinated people traveling for medical reasons, such as getting vaccinated, are exempt if they can show proof.

“Because it is a national emergency, it is my position that we can restrain [unvaccinated individuals],” Duterte said in a televised speech Jan. 6.

On the first day of the policy’s implementation, Jan. 17, police and transport officials apprehended hundreds of unvaccinated passengers and prevented them from riding buses, jeepneys and trains.

A TV interview of a partially vaccinated woman who had been prevented from boarding a bus went viral and sparked criticism of the policy.

“I’m so tired. What the government is doing is making me tired. I’m partially vaccinated. It’s not my fault that my second dose is scheduled for February,” she said.

After a barrage of criticism, the government was forced to temporarily walk back the policy on the second day of implementation, introducing exemptions, including for unvaccinated essential workers and those leaving their homes for medical reasons.

Following a trend around the world, the surge quickly subsided in February, as predicted by government and private experts, but the country is still reporting nearly 10,000 cases per day.

As the number of daily reported cases in Metro Manila dropped, the Department of Transportation has now temporarily suspended the policy as of Feb. 1. However, the ban will be reinstated once the city breaches a higher caseload.

Human rights, labor and mobility advocates have called on the government to revoke the ban, saying it restricts the exercise of fundamental rights, and calling it unnecessary, discriminatory and anti-poor, as most of the city’s 14 million people are commuters and cannot afford cars.

“Restricting mobility is not the answer to the gaps in the vaccination campaign, regardless of whether that’s availability or accessibility to vaccines, or for a mere addressing of the continued misinformation about vaccination,” Ira Cruz, director of AltMobility PH, a group advocating sustainable transport, told VOA.

There are more than 50 million fully vaccinated people in the Philippines, according to the government, but the country failed to meet its vaccination target last year.

Like many countries, the Philippines is battling vaccine misinformation, but resistance to vaccination is waning. The most recent poll showed that of Filipinos surveyed in December, only 8% are unwilling to be vaccinated, down from 18% in September 2021.

“Why people don’t want to get vaccinated, that remains to be the responsibility of the government to address. What this is sounding like is that the government is giving up on addressing the gaps of a vaccination campaign and closing its doors to certain people,” Cruz said.

He said it would be more useful for the government to provide a steady supply of buses, trains and jeepneys so there’s enough room to follow public health protocols, including physical distancing.

“We call on the government to revoke the ban altogether regardless of the number of cases in the country,” Cruz said.  

 

 
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NASA says global temperatures are on the rise, and that could spell trouble for future Winter Games. Plus, Australian astronomers discover an unidentified space object, and a pair of satellites touch the sky. VOA’s Arash Arabasadi brings us a Winter Olympics-edition of The Week in Space.
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The World Health Organization’s European region director says that while COVID-19 cases on the continent continue to rise, he sees a plausible endgame for the pandemic in Europe in coming months.

Speaking during his weekly virtual news briefing from his headquarters in Copenhagen, WHO Europe Region Director Hans Kluge told reporters the region recorded 12 million cases in the past week, the highest weekly case incidence since the start of the pandemic, largely driven by the omicron variant.

But Kluge said, while hospitalizations continue to rise – mainly in countries with lower vaccination rates — they have not risen as fast as the rate of new infection, and admissions to intensive care units have not increased significantly. Meanwhile, deaths from COVID-19 have remained steady.

Kluge said the pandemic is far from over, but, for the first time, he sees what he called an opportunity to take control of transmission of disease because of the presence of three factors: an ample supply of vaccine plus immunity derived from a large number of people having had COVID-19; the favorable change of the seasons as the region moves out of winter; and the now-established lower severity of the omicron variant.

The WHO regional director said those factors present the possibility of “a long period of tranquility” and a much higher level of population defense against any resurgence in transmission, even with the more virulent omicron variant.

Kluge called it “a cease-fire that could bring us enduring peace,” but only if nations continue vaccinating and boosting, focusing on the most vulnerable populations, and people continue “self-protecting behavior,” such as masking and social distancing, though he added, “with lower governmental oversight to limit unnecessary socio-economic impacts.”

More nations in Europe are scaling back or removing government-imposed COVID-19-related restrictions.

Kluge said officials need to intensify surveillance to detect new variants. He said new strains are inevitable, but he believes it is possible to respond to them without the disruptive measures that were needed early in the pandemic.

Some information in this report came from the Associated Press.
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Crushing fatigue. Brain fog. Trouble breathing weeks after contracting COVID-19. Scientists call it post-acute sequelae of COVID-19. Most people just call it “long COVID.”

For millions of people, these and other symptoms are keeping them from getting back to their lives months after their last positive COVID-19 test.

But what is long COVID, exactly? How common is it? Who gets it, and why?

As with so many things over the past two pandemic years, the answer to the most basic questions is, “We don’t know yet.”

Studies are starting to narrow things down. But a lot still is up in the air.

“I would take everything we have so far with a grain of salt,” Dr. Nahid Bhadelia, founding director of the Boston University Center for Emerging Infectious Diseases Policy and Research, said on a press call organized by the Infectious Diseases Society of America.

The silver lining may be that with so many suffering the aftereffects of COVID-19, research may shed light on similar but poorly understood syndromes, such as chronic fatigue syndrome that have debilitated people long before COVID-19 showed up.

With time and support, “the majority — and I would almost say the vast majority — of people with long COVID will get better,” added Dr. Kathleen Bell, chair of the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center. “But I don’t think, at this point, that anyone can say how long does long COVID last.”

How common is it?

Estimates of how many people get long COVID are all over the map.

An analysis summing up 57 studies on the subject found that on average, more than half of COVID-19 patients still had symptoms six months after infection.

But the range was enormous. In some of the studies, less than a quarter of patients had long-term symptoms, while in others, three-quarters did.

One of the difficulties with pinning down long COVID is defining what it is and what it isn’t.

“Currently, the bucket is very large,” Bhadelia said. “It’s anybody who has persistent symptoms four weeks or longer” after infection.

Fatigue is the most common symptom. Many complain of “brain fog” — memory problems and difficulty concentrating or processing information. Patients frequently have trouble breathing. Other common symptoms include headaches, muscle pain, rapid heartbeat, dizziness or ringing in the ears.

There’s also a lot of anxiety, depression and insomnia, which may be partly reactions to the symptoms but also appear to be related to the virus itself, Bell said.

The challenge for both doctors and patients is that many other things can cause these symptoms besides long COVID, she noted.

Who gets it?

Vaccination cut the rate of long COVID symptoms in half in one study and down to baseline in another.

Diabetes and asthma raise the risk.

People who got seriously ill with COVID-19 are more likely to have prolonged symptoms, but even some people who had only mild to moderate cases are struggling months later.

“In general, you can say that people who have more severe infections will have a longer period of time of recovery. But that’s not the whole story,” Bell said.

Some recent studies are pointing to what may be causing long COVID, but nothing is conclusive yet.

One theory is that long COVID is an autoimmune condition in which the immune system mistakenly attacks the patient’s own body.

In a new study, researchers found patients with long COVID had high levels of antibodies to components of the patient’s own immune system, even though very few of them had a previously diagnosed autoimmune condition.

Viral reawakening?

The study also raised the possibility that COVID-19 wakes up latent infection of another common virus, called Epstein-Barr.

An estimated 90% of the world’s population carries the Epstein-Barr virus, but usually the immune system keeps it under control.

The virus also causes mononucleosis, which “puts you flat on your back with fatigue for a month or more, which is not that different from some long COVID symptoms,” study co-author James Heath, president of the University of Washington Institute for Systems Biology, noted in a YouTube video the institute posted.

Overactive inflammation may be another factor, perhaps involving tiny blood clots carrying inflammatory molecules throughout the body.

Whatever the cause, COVID-19 is not the only ailment to leave patients with lingering symptoms.

Scientists are studying persistent headaches, joint pain and vision problems in Ebola survivors in West Africa. Chikungunya can leave patients with arthritis lasting months. Other viral illnesses may leave patients with chronic fatigue syndrome.

“We just haven’t understood many of these conditions,” Bhadelia, at Boston University, said.

Now that there are millions of people suffering with long-term, debilitating symptoms, scientists may learn a lot more about what causes them and how to treat them.

“This is going to tell us a lot more about other viruses and other pathogens,” Bhadelia said. “Everything that affects us from our environment, everything that triggers a change in our body, leaves a fingerprint on us.” 
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