Eight months into the COVID-19 pandemic, we’re still getting sucker-punched by the disease. Just when we think we’ve figured it out, it throws us another surprise. It’s principally a pulmonary affliction, right? Well, it attacks the brain and heart, too. It pretty much leaves young people alone? Not so much, it increasingly seems. But at least we know something about the disease’s usual course: assuming an infected person doesn’t require hospitalization, they should be healthy again in two or three weeks, tops.
Or not.
As my colleague Jamie Ducharme reports, researchers are increasingly finding patients who are still suffering long after contracting the disease. In one survey by the U.S. Centers for Disease Control and Prevention, 35% of non-hospitalized patients in a sample group of 300 were still symptomatic up to three weeks after first falling ill. In a University of California, San Francisco, research group, about 20% of patients were still suffering one to four months after symptoms first appeared.
“Half of my day is spent trying to sleep, and the other half of it is trying to pretend like I’m okay—and I don’t know when I’ll be okay,” Kayla Brim, a 28-year-old from Caldwell, Idaho who's been sick since July 2, told Ducharme.
She’s not alone. You know you’ve got a problem when social media support groups like the “Survivors Corps” start popping up to help sufferers. You know you’ve got a problem when some of the people who join said groups give themselves a nickname: ”long-haulers.” And you definitely know you’ve got a problem when a mysterious ailment gets an informal title of its own: “long COVID.”
Long COVID could further strain the world’s already struggling medical infrastructure. Dr. Zijian Chen, medical director of the Center for Post-COVID Care at New York City’s Mount Sinai Health System, tells TIME he worries about “an impending tsunami of patients…on top of all the [usual] chronic care that we do. At some point it becomes very unsustainable—meaning, the system will collapse.”
It would help if doctors could figure out what causes long COVID. It’s possible that the virus hides out in some yet-unidentified part of a person’s body, wreaking havoc for a long stretch. It’s also possible that the infection tips some people's immune systems into overdrive, which may lead to the lingering symptoms.
“That's very much an area of ongoing research,” says Ducharme. “It seems logical that if a hyperactive immune system can cause some of COVID-19's worst complications, it could also result in long-term illness. There are lots of other viral illnesses that persist for that reason.”
Whatever the answer, it’s clear that a disease that has already caused much suffering and death around the world is not through doing its terrible damage in ways we perhaps have not yet begun to imagine.
More than 21.8 million people around the world had been sickened by COVID-19 as of 1 AM eastern time today, and more than 774,000 people have died.
Here is every country with over 300,000 confirmed cases:
Just months after becoming Europe’s ground zero for the virus, a mostly-recovered Italy is taking a big symbolic step: the launch of the first cruise ship to leave Italian ports since the pandemic began. Cruise lines are a big part of Italy’s vital tourism sector, with about 12 million passengers arriving, departing or making ports of call on the Italian coast in an average year. The crew of the ship setting sail—the MSC Grandiosa—went into medical quarantine before the start of the seven-day journey; passengers will be tested and have their temperature checked before boarding.
Think Italy’s leisure industry looks confident as the country bounces back from the contagion? Try China, where the city of Wuhan—the place in which the disease first broke free—hosted a massive party at a local water park over the weekend. The unmasked, non-socially-distanced crowd was there for both the water and an electronic music festival and they packed in shoulder to shoulder, as if the virus—which forced the entire city into a 76-day lockdown earlier in the year—did not exist at all.
The tally of cases linked to a South Korean megachurch continues to climb, rising 50% today to a total of 457. The outbreak comes after Jun Kwang-hoon, the church’s conservative pastor, led a protest march against the government’s social distancing measures. Kwon Jun-wook, director of South Korea’s National Health Institute, worries the flare-up could lead to developments comparable to the “miserable scenes of the United States or European countries,” the Associated Press reports.
Natural herd immunity—the idea that the virus would simply go away if enough people were exposed to it and developed antibodies for it—sounds like a nice idea, but the World Health Organization is not impressed. “As a global population, we are nowhere close to the levels of immunity required to stop this disease transmitting,” said the WHO’s emergencies chief, Dr. Michael Ryan, in response to a question during a press briefing today. “This is not a solution we should be looking to.” Achieving herd immunity without a vaccine would require at least 70% of the global population to be infected—but so far, only 10-20% of all people have antibodies to the virus, and nearly 775,000 have already died, a number that would surely increase if more people were exposed.
The Situation in the U.S.
The U.S. had recorded more than 5.4 million coronavirus cases as of 7 AM eastern time today. More than 170,000 people have died. Here's where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
On August 17, there were 35,112 new cases and 445 new deaths confirmed in the U.S. Here's how the country as a whole is currently trending:
The United States Postal Service is delaying a series of controversial moves until after this November's election, the Wall Street Journalreports. The decision comes amid concerns that U.S. Postmaster General Louis DeJoy, a donor to U.S. President Donald Trump, was purposefully tampering with the agency's ability to process mail-in ballots during an election when many Americans are likely to vote by mail due to concerns about the virus. “To avoid even the appearance of any impact on election mail, I am suspending these initiatives until after the election is concluded," DeJoy said. At least some of the measures that have made headlines in recent days predated DeJoy.
Just a week after reopening for in-person classes, The University of North Carolina, Chapel Hill has closed once again after 130 students tested positive for the virus. Huge outdoor parties surely did nothing to contain either the virus or the withering criticism UNC leaders are receiving for reopening despite warnings from local health officials. "As much as we believe we have worked diligently to help create a healthy and safe campus living and learning environment, we believe the current data presents an untenable situation," the chancellor and vice chancellor said in a joint statement. The student newspaper disagrees with the “worked diligently” part, running an editorial headlined: “We all saw this coming.”
It’s been nearly two months since a federal judge ordered the release of 120 children held by U.S. Immigration and Customs Enforcement (ICE) at three detention centers nationwide for fear of viral exposure. And it’s been more than three weeks since the July 27 deadline for complying with the order passed. Yet the children remain detained. It’s not just the government responsible for the stalemate—at an Aug. 7 hearing, lawyers representing ICE and those representing the children both said that they haven’t come up with a safe way to release and place the detainees. But the status quo is hardly safe either; 73 adults and children have already tested positive at one Texas detention center.
The U.S. nursing home industry yesterday reported an alarming 80% increase in coronavirus cases in its facilities since the pandemic rebounded in June, per the AP. Case growth has spiked the highest in the South and West. Less than 1% of the U.S. population lives in long-term care facilities, but residents make up 40% of overall virus deaths. Though nursing homes are often largely isolated from the outside community, health officials believe the virus leaks into the facilities via employees who don’t know they’re infected.
White House Coronavirus Task Force Coordinator Dr. Deborah Birx said yesterday that she wishes the U.S. had followed Italy’s example of a near-total lockdown early in the pandemic. "When Italy locked down, I mean, people weren't allowed out of their houses," Brix said at a roundtable led by Arksanas governor Asa Hutchinson. But she added that "Americans don't react well to that kind of prohibition." Jared Kushner, President Donald Trump’s son-in-law and White House senior adviser, pushed back, telling CNN that "I think we have done much better than Italy with regards to how we handled this initially."
All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of August 18, 1 AM eastern time. To see larger, interactive versions of these maps and charts, click here.
WHAT ELSE YOU SHOULD KNOW
Some Hope for Long-Term Immunity
A cluster of new studies suggests that the human immune system may do a better job than we think of providing long-term immunity against the virus. The research is decidedly tentative—some has yet to be peer-reviewed—but it comes out of an impressive array of institutions, including Duke University and the La Jolla Institute for Immunology. Read more here.
A New Link Between COVID-19 and Diabetes?
Parents have long worried that children with Type 1 diabetes are at increased risk of contracting or developing more serious cases of the virus, though the science is not yet settled. But a small new study out of Imperial College London suggest the causation could also work in the other direction, with viral infections appearing to be linked to a spike in new cases of Type 1 diabetes. Read more here.
Why Bars Are Such a Big Problem
Never mind cruise ships, nursing homes and prisons—it’s bars that are perhaps the worst force multiplier for the coronavirus. There are a lot of reasons they earn that dubious honor: big crowds, small spaces, the impossibility of drinking through a mask and the disinhibiting effects of alcohol. Read more here.
Governor Cuomo Becomes Author Cuomo
It was inevitable that the pandemic would start resulting in book deals, and New York governor Andrew Cuomo is one of the first out of the gate, with today's announcement that publisher Crown will be releasing his American Crisis in mid-October. Cuomo, who became something of an icon of calm stewardship in the face of disaster, says he did not always feel as calm as he looked during his daily press briefings. “If you don’t feel fear, you don’t appreciate the consequences of the circumstance,” he writes. Read more here.
Thanks for reading. We hope you find the Coronavirus Brief newsletter to be a helpful tool to navigate this very complex situation, and welcome feedback at coronavirus.brief@time.com.
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Correction: Yesterday's newsletter misstated the date of the upcoming presidential election in the United States. It is Nov. 3, 2020, not Nov. 6, 2020.
Today's newsletter was written by Alex Fitzpatrick and edited by Elijah Wolfson.
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