On Tuesday, curiosity finally got the best of me. How potent could Panera’s Charged Lemonades really be? Within minutes of my first sip of the hyper-caffeinated drink in its strawberry-lemon-mint flavor, I understood why memes have likened it to an illicit drug. My vision sharpened; sweat slicked my palms.
Laced with more caffeine than a typical energy drink, Panera’s Charged Lemonade has been implicated in two wrongful-death lawsuits since it was introduced in 2022. Though both customers who died had health issues that made them sensitive to caffeine, a third lawsuit this month alleges that the lemonade gave an otherwise healthy 27-year-old lasting heart problems. Following the second death, Panera denied that the drink was the cause, but in light of the lawsuits it has added warnings about the drink, reduced its caffeine content, and removed the option for customers to serve themselves.
All the attention on Panera’s Charged Lemonade has resurfaced an age-old question: How much caffeine is too much? You won’t find a simple answer anywhere. Caffeine consumption is widely considered to be beneficial because it mostly is—boosting alertness, productivity, and even mood. But there is a point when guzzling caffeine tips over into uncomfortable, possibly unhealthy territory. The problem is that defining this point in discrete terms is virtually impossible. In the era of extreme caffeine, this is a dangerous way to live.
Most people don’t have to worry about dying after drinking Charged Lemonade. The effects, though uncomfortable, usually seem to be minor. After drinking half of mine, I was so wired that I couldn’t make sense of the thoughts ricocheting around my brain for the next few hours. Caffeine routinely leads to jitteriness, nervousness, sweating, insomnia, and rapid heartbeat. If mild, such symptoms can be well worth the benefits.
But consuming too much caffeine can have serious health impacts. High doses—more than 1,000 milligrams a day—can result in a state of intoxication known as caffeinism. The symptoms can be severe: People can “develop seizures and life-threatening irregularities of the heartbeat,” and some die, David Juurlink, a toxicology professor at the University of Toronto who also works at the Ontario Poison Centre, told me. “It’s one of the dirty little secrets, I’m afraid, of caffeine.” Juurlink said he occasionally gets calls about people, typically high-school or college students, who have ingested multiple caffeine pills on a dare or in a suicide attempt.
You’re unlikely to ingest that much caffeine from beverages alone, yet the increasing availability of highly caffeinated products makes it more of a possibility than ever before. Besides Panera’s Charged Lemonade, dozens of energy drinks contain similar amounts of caffeine, and some come in candy-inspired flavors such as Bubblicious and Sour Patch Kids. Less potent but highly snackable products include caffeinated coffee cubes, energy chews, marshmallows, mints, ice pops, and even vapes. Consumed quickly and in rapid succession, these foods can lead to potentially toxic caffeine intake “because your body hasn’t had time to tell you to stop,” Jennifer Temple, a professor at the University of Buffalo who studies caffeine use, told me.
More than ever, we need a way to track our caffeine consumption, but we don’t seem to have any good options. In all of the lawsuits against Panera, the basic argument is this: Had the company more adequately warned customers of the drink’s caffeine content, perhaps no one would have been hurt. But most of us just aren’t used to thinking about caffeine in numerical terms the way we do with calories and alcohol by volume (ABV). Caffeine intake is generally something that’s not measured but experienced: I know, for example, that a double espresso from the office coffee machine will give me the shakes. But even though I knew how much caffeine is in a Charged Lemonade, I had no idea how much of it I could drink before having the same reaction.
The FDA does have a recommended daily caffeine limit of 400 milligrams, the equivalent of about four or five cups of coffee. “Based on the relevant science and information available,” a spokesperson told me, consuming that much each day “does not raise safety concerns” for most adults, except for people who are pregnant or nursing, or have concerns related to their health conditions or the medication they take. The agency, however, doesn’t require food labels to note caffeine content, though some companies include that information voluntarily.
But the numbers are helpful only up to a point. The FDA’s daily recommendation is a “rough guideline” that can’t be used as a universal standard, because “it’s not safe for everybody,” Temple said. For one person, 237 milligrams could mean a trip to the hospital; for another, that would just be breakfast. The effect of a given caffeine dose “varies tremendously from person to person based upon their historical pattern of use and also their genetics,” Juurlink told me.
Although people generally aren’t aware of the amounts of caffeine they consume, they tend to develop a good sense of how much they can handle, Temple said. But usually, this knowledge is product-specific; when trying a new caffeine product, the effect can be hard to predict. Part of the problem is that the amount of caffeine in products varies dramatically, even among drinks that may seem similar: A 12-ounce Americano from McDonald’s contains 71 milligrams of caffeine, but the same drink at Starbucks contains 150 milligrams. The caffeine in popular energy drinks ranges from 75 milligrams (Ocean Spray Cran-Energy) to 316 milligrams (Redline Xtreme), according to the Center for Science in the Public Interest.
Contrast this with alcohol, which tends to be served in conventional units regardless of brand: a can of beer, a glass of wine, or a shot of liquor, all of which have roughly the same ability to intoxicate. Having a standard unit to gauge consumption isn’t foolproof—consuming too much alcohol is still far too easy—but it is nevertheless helpful for thinking about how much you’re ingesting, as well as the differences between beverages. Without such a metric for caffeine, consuming new beverages takes on a daredevil quality. Sipping the Charged Lemonade felt like venturing into the Wild West of caffeine.
The reason we aren’t good at thinking about caffeine is that historically, we’ve never really had to think that hard about it. Sure, one too many espressos might have occasionally put someone over the edge, but caffeine was consumed and sold in amounts that didn’t require as much thought or caution. “A generation ago, you didn’t have all these energy drinks,” so people didn’t grow up learning about safe caffeine consumption the way they may have done for alcohol, Darin Detwiler, an food-policy expert at Northeastern University, told me.
Compounding the concern is the fact that energy drinks are popular with kids, who are more susceptible to caffeine’s effects because they’re smaller. Kids tend to drink even more when drinks are labeled as highly caffeinated, Temple said, and the fact that they contain huge amounts of sugar to mask the bitter taste of caffeine adds to their appeal. Last year, a child reportedly went into cardiac arrest after drinking a can of Prime Energy—prompting Senator Chuck Schumer to call on the FDA to investigate its “eye-popping caffeine content.”
Nothing else in our daily diet is quite like caffeine. Certainly people swear by it, and its benefits are clear: Research shows that it can improve cognitive performance, speed up reaction time, and boost logical reasoning, and it may even reduce the risk of Parkinson’s, diabetes, liver disease, and cancer. But for a substance so ubiquitous that it’s called the most widely used drug in the world, our grasp of how to maximize its benefits is feeble at best. Even the most seasoned coffee drinkers sometimes unintentionally get too wired; as new, more highly caffeinated products become available, instances of caffeine drinkers overdoing it will probably become more common. Perhaps the best we can do is learn how much of each drink we can handle, one super-charged sip at a time.
This year, I’m going to get into shape. It does not matter that I’ve made this same resolution every year for more than a decade, or that I gave up after a month each time. In 2024, I mean it. Unlike years past, my motivation is not aesthetic but utilitarian: I want to get fit so I stop feeling like garbage. As I enter my late 30s, I’m struggling with the health issues that come with the terrain—high blood pressure, lower-back pain, and persistently achy joints. On top of those, I’m a new mom, chronically sleep-deprived and exhausted. My six-month-old son saps all my energy but also steels my resolve to protect it.
With all my new motivation, I first had to find a workout regime. Scrolling through social media for inspiration, I saw athletes of every variety across my feed. There were people sweating it out at a Navy SEAL–style workout, a Muay Thai–inspired kickboxing class, and a workout designed and taught by former inmates. Yoga isn’t just yoga anymore; it can be hot, aerial, acrobatic, Drake, and even goat. Personal trainers shout commands through media including YouTube, VR headsets, and, uh, mirrors. You can work out alone or in a group (or alone in a group, if Peloton is your thing). For the graceful, there is barre; for the nerds, there is a Lord of the Rings–themed app that logs exercise as movement from the Shire to Mordor.
We are living in a golden age of fitness: With workouts to accommodate every skill level, interest, time commitment, and social capacity, it should be easier than ever for novices to find one and get started. But it’s not. Instead of finding a workout that suited me, choice overload left me even more inert, and less motivated, than I was when I started my search. If you’re serious about committing to a fitness regime, choosing one isn’t just about moving your body. It could shape your future schedule, lifestyle, and even identity. To others, the way you exercise might say something about who you are, whether that’s a marathon maniac or a #PelotonMom. To the exercise newbie, this can make the stakes feel dauntingly high.
The stakes are high. Exercise will lead to results only if you do it consistently, potentially spending hours on it each week. It’s essential to pick right. I was never fitter than when I played in a basketball league in my early 20s and was held accountable for going to games and practice. Since then, I’ve only dabbled in activities—like kickboxing, spinning, and something called Dance Church. None of them stuck. In the search for the ideal workout, baseline criteria include practical concerns such as location and affordability. No matter how exciting the class, a gym that’s out of the way or prohibitively expensive is not one you will attend regularly. Then there is what I call doability—as in, Can my body do that? Answering honestly can eliminate unlikely options, such as the gruelingcircuit that turned actors into Spartans for the movie 300. Being too pragmatic, however, can also stifle fitness aspirations. If your goal is an eight-pack, the “lazy-girl workout” probably isn’t going to cut it.
Ruling out options based on practicality only whittles the list down so much. The next step is harder: figuring out what you actually want to do. For a goal as broad as “get in shape,” you can drive yourself crazy trying to find the answer. Picking a workout that ticks all the boxes is virtually impossible, because there will always be other options that seem better. At first, streaming Yoga With Adriene in my living room seemed like a cheap, enjoyable, and physically demanding option, but it lacked a social component to hold me accountable. Programs inspired by high-intensity interval training (HIIT), such as F45, promise to get people ripped—fast!—but exercising under a constant deadline is my idea of hell. I found flaws in workouts as varied as rock climbing, rugby, Orangetheory, Tabata, Aqua Tabata, and Tabata-style spinning.
Adding to the gravity of the decision is what it signals about who you are. Personal fitness is rarely personal these days. Stereotypes inform the culture of certain workouts and how their adherents are seen: Indoor rock climbing is associated with tech bros, running with intensely driven morning people, weight lifting with gym rats. Many boutique workouts come with even more distinct personality types, perpetuated by the communities they spawn in real life and on social media. Perhaps the most recognizable is the CrossFit Bro, an aggressive, bandanna-wearing jock who can’t stop talking about CrossFit. Pure Barre and SoulCycle call to mind lithe, athleisure-clad smoothie drinkers; Peloton, the kind of person who can afford a Peloton.
New identities can also form by virtue of the lifestyle shifts that these workouts can bring about. Friendships are nurtured by sweat spilled during class; exercise may even shift eating habits. For some, fitness programs become so embedded in daily life that they begin to resemble institutionalized religion. In an extreme case of life imitating exercise, a couple who met at CrossFit got married and served a paleo cake at their wedding, which was held during a CrossFit competition. Because exercise is so good at fostering community, the search for a workout is sometimes described as finding “your tribe.”
These stereotypes are not always true, of course, and they can also be aspirational. Embarrassed as I am to admit it, I would love to be a smoothie girl. But the notion of joining a tribe makes pedaling on a stationary bike or joining a rock-climbing gym feel much more consequential than the activities themselves. I was getting nowhere in my own fitness search, so I turned to experts for a reality check. Selecting from a multitude of fitness options is “quite a dilemma,” Sarah Ullrich-French, a kinesiology professor at Washington State University, told me, but the way out is to focus on what feels good, physically and psychologically. Fitness identities, however palpable, only have to mean something if you want them to. If the stereotype of the intensely focused predawn runner inspires you to get up for a morning jog, lean into it. But if it seems like an annoying downside to running, it’s okay to treat it as such. Pay attention to workouts that bring up anxiety and dread; even if you aspire towards a certain identity, “negative associations and feelings will often win over our goals and what we think we should do,” Ullrich-French said.
Part of my problem was having a goal that was too diffuse. Theoretically any workout could help me get fit, but if I refined my ambition to, say, “getting up the stairs to work without heaving,” doing so would narrow my options to exercises that optimize stamina and strength. Instead of immediately signing up for a weekly running club, start with small, attainable goals, such as taking the time to stretch each morning, Adam Makkawi, an assistant professor of medicine at Columbia University, told me. Small goals are easier to achieve, and can help make more workout options a real possibility.
My biggest mistake was to treat choosing a workout as an intellectual endeavor, sort of like shopping for a new vacuum by reading endless online reviews. Test several options, and when you’ve found one that you like, customize its intensity and frequency until it suits you, Catherine Sabiston, a professor of kinesiology and physical education at the University of Toronto, told me. The likelihood you’ll stick to it, she added, boils down to competency—how well you feel you can accomplish a task—and enjoyment, both of which can be known only through experience.
Choice overload is real, but it can also be a powerful excuse to stay inert. Although a little self-reflection about fitness identities can be helpful, fixating on them can rule out perfectly viable options. In this spirit, I compiled a list of doable, challenging, and conceivably fun workouts to try—and even mustered up excitement for a fitness identity that brought me joy. This week, I begin my search in earnest, embarking on a virtual Lord of the Rings running journey across the rugged terrain of Middle Earth.
If anything defines America’s current obesity-drug boom, it’s this: Many more people want these injections than can actually get them. The roadblocks include exorbitant costs that can stretch beyond $1,000 a month, limited insurance coverage, and constant supply shortages. But before all of those issues come into play, anyone attempting to get a prescription will inevitably confront the same obstacle: their body mass index, or BMI.
So much depends on the simple calculation of dividing one’s weight by the square of their height. According to the FDA, people qualify for prescriptions of Wegovy and Zepbound—the obesity-drug versions of the diabetes medications Ozempic and Mounjaro—only if their BMI is 3o or higher, or 27 or higher with a weight-related health issue such as hypertension. Many who do get on the medication use BMI to track their progress. That BMI is the single biggest factor determining who gets prescribed these drugs, and who doesn’t, is the result of how deeply entrenched this metric has become in how both doctors and regular people approach health: Low BMI is good and high BMI is bad, or so most of us have come to think.
This roughly 200-year-old metric has never been more relevant—or maligned—than it is in the obesity-drug era. BMI has become like the decrepit car you keep driving because it still sort of works and is too much of a hassle to replace. Its numerous shortcomings have been called out for many years now: For starters, it accounts for only height and weight, not other, more pertinent measures such as body-fat percentage. In June, the American Medical Association formally recognized that BMI should not be used alone as a health measure. Last year, some doctors called for BMI to be retired altogether, echoing previousassertions.
The thing is, BMI can be an insightful health metric, but only when used judiciously with other factors. The problem is that it often hasn’t been. Just as obesity drugs are taking off, however, professional views are changing. People are so accustomed to seeing BMI as the “be-all, end-all” of health indicators, Kate Bauer, a nutritional-sciences professor at the University of Michigan, told me. “But that’s increasingly not the way it’s being used in clinical practice.” A shift in the medical field is a good start, but the bigger challenge will be getting everyone else to catch up.
BMI got its start in the 1830s, when a Belgian astronomer named Adolphe Quetelet attempted to determine the properties of the “average” man. Using data on primarily white people, he observed that weight tended to vary as the square of height—a calculation that came to be known as Quetelet’s index.
Over the next 150 years, what began as a descriptive tool transformed into a prescriptive one. Quetelet’s index (and other metrics like it) informed height-weight tables used by life-insurance companies to estimate risk. These sorts of tables formed “recommendations for the general population going from ‘average’ to ‘ideal’ weights,” the epidemiologist Katherine Flegal wrote in her history of BMI; eventually, nonideal weights were classified as “overweight” and “obese.” In 1972, the American physiologist Ancel Keys proposed using Quetelet’s index—which he renamed BMI—to roughly measure obesity. We’ve been stuck with BMI ever since. The metric became embedded not only in research and doctor’s visits but also in the very definitions of obesity. According to the World Health Organization, a BMI starting at 25 and less than 30 is considered overweight; anything above that range is obese.
But using BMI to categorize a person’s health was controversial from the start. Even Keys called it “scientifically indefensible” to use BMI to judge someone as overweight. BMI doesn’t account for where fat is distributed on the body; fat that builds up around organs and tissues, called visceral fat, is linked to serious medical issues, while fat under the skin—the kind you can pinch—is usually less of a problem. Muscularity is also overlooked: LeBron James, for example, would be considered overweight. Both fat distribution and muscularity can vary widely across sex, age, and ethnicity. People with high BMIs can be perfectly healthy, and “there are people with normal BMIs that are actually sick because they have too much body fat,” Angela Fitch, an assistant professor at Harvard Medical School and the president of the Obesity Medicine Association, told me.
For all its flaws, BMI is actually useful at the population level, Fitch said, and doctors can measure it quickly and cheaply. But BMI becomes troubling when it is all that doctors see. In some cases, the moment when a patient’s BMI is calculated by their doctor may shape the rest of the appointment and relationship going forward. “The default is to hyper-focus on the weight number, and I just don’t think that that’s helpful,” Tracy Richmond, a pediatrics professor at Harvard Medical School, told me. Anti-obesity bias is well documented among physicians—even some obesity specialists—and can lead them to dismiss the legitimate medical needs of people with a high BMI. In one tragic example, a patient died from cancer that went undiagnosed because her doctors attributed her health issues to her high BMI.
But after many decades, the medical community has begun to use BMI in a different way. “More and more clinicians are realizing that there are people who can be quite healthy with a high BMI,” Kate Bauer said. The shift has been gradual, though it was given a boost by the AMA policy update earlier this year: “Hopefully that will help clinicians make a change to supplement BMI with other measures,” Aayush Visaria, an internal-medicine resident at Rutgers Robert Wood Johnson Medical School who researches BMI’s shortcomings, told me.
Physicians I spoke with acknowledged BMI’s flaws but didn’t seem too concerned about its continued use in medicine—even as obesity drugs make this metric even more consequential. BMI isn’t a problem, they said, as long as physicians consider other factors when diagnosing obesity or prescribing drugs to treat it. If you go to a doctor with the intention of getting on an obesity drug, you should be subject to a comprehensive evaluation including metrics such as blood sugar, cholesterol levels, and body composition that go “way beyond BMI,” Katherine Saunders, a clinical-medicine professor at Weill Cornell Medicine, said. Because Wegovy and other drugs come with side effects, she told me, doctors must be absolutely sure that a patient actually needs them, she added.
But BMI isn’t like most other health metrics. Because of its simplicity, it has seeped out of doctor’s offices and into the mainstream, where this more nuanced view still isn’t common. Whether we realize it or not, BMI is central to our basic idea of health, affecting nearly every aspect of daily life. Insurance companies are notorious for charging higher rates to people with high BMI and lowering premiums for people who commit to long-term weight loss. Fertility treatments and orthopedic and gender-affirming surgery can be withheld from patients until they hit BMI targets. Workplace wellness programs based on BMI are designed to help employees manage their weight. BMI has even been used to prevent prospective parents from adopting a child.
The rise of obesity drugs may make these kinds of usages of BMI even harder to shake. Determining drug eligibility by high BMI supports the notion that a number is synonymous with illness. Certainly many people using obesity drugs take a holistic view of their health, as doctors are learning to do. But focusing on BMI is still common. Some members of the r/Ozempic Subreddit, for example, share their BMI to show their progress on the drug. Again, high BMI can be used to predict who has obesity, but it isn’t itself an obesity diagnosis. The problem with BMI’s continued dominance is that it makes it even harder to move away from simply associating a number on a scale with overall health, with all the downstream consequences that come along with a weight-obsessed culture. As obesity drugs are becoming mainstream, “there needs to be public education explaining that BMI by itself may not be a good indicator of health,” Visaria said.
In another 200 years, surely BMI will finally be supplanted by something else. If not much sooner: A large effort to establish hard biological criteria for obesity is under way; the goal is to eliminate BMI-based definitions once and for all. Caroline Apovian, a professor at Harvard Medical School, gives it “at least 10 years” before a comparably cheap or convenient replacement arises—though any changes would take longer to filter into public consciousness.” Until that happens, we’re stuck with BMI, and the mess it has wrought.
JOHANNESBURG (AP) — An elevator suddenly dropped around 200 meters (656 feet) while carrying workers to the surface in a platinum mine in South Africa, killing 11 and injuring 75, the mine operator said Tuesday.
It happened Monday evening at the end of the workers’ shift at a mine in the northern city of Rustenburg. The injured workers were hospitalized.
Ford Motor Executive Chair Bill Ford called for a resolution to an “acrimonious” round of talks with the United Auto Workers and warned that a continuing strike could hurt the company’s ability to keep factory jobs in the U.S.
Retail executives over the past year have talked a lot about “shrink” — or the losses they take due to theft, fraud or employee error — amid a flood of headlines about sometimes violent organized thefts at stores. But results from a retail-industry survey released Tuesday found the metric rose only modestly last year.
The report from the National Retail Federation, a retail industry group, found that the average shrink rate in 2022 crept higher to 1.6% from 1.4% in the prior year, when calculated as a share of sales. The figure from 2022 is in line with those seen in 2020 and 2019.
Still, the losses amounted to billions of dollars — $112.1 billion, up from $93.9 billion in 2021 — according to the report. And the report said that retailers were increasingly concerned about the violence of those crimes.
“Far beyond the financial impact of these crimes, the violence and concerns over safety continue to be the priority for all retailers, regardless of size or category,” David Johnston, the NRF’s vice president for asset protection and retail operations, said in a statement.
The NRF, working with the Loss Prevention Research Council — a research group founded by some of the nation’s biggest retailers — surveyed people in the industry who work in loss-prevention and asset protection. The report contained responses or information from 177 retail brands. The survey was distributed in May, June and July.
“In this case, we cannot continue operating these stores because theft and organized retail crime are threatening the safety of our team and guests, and contributing to unsustainable business performance,” Target said in a statement.
The chain joins other retailers sounding the alarm about retail theft and closing stores, amid what executives have described as a spike in organized retail theft, or theft with the intent of reselling the goods. However, executives’ takes on earnings calls have differed slightly, and retailers are contending with other issues — like the fallout from inflation — that have hit financials.
The fight over theft has played out, perhaps predictably, on partisan lines, with some blaming what they say are lax crime policies in large cities. But other analysts point to changes in the flow of foot traffic through population centers since the pandemic, and say the data is often too squishy and subjective to make any hard calls about the state of crime — and whether it’s rising or falling, particularly at retailers — in a particular area.
More than two-thirds of the retailers surveyed by the NRF “said they were seeing even more violence and aggression” from organized retail theft compared with a year ago. Twenty-eight percent reported being “forced” to close a specific store location, the report said, while 45% said they cut operating hours, and 30% said they reduced or changed an in-store product selection as a result of retail crime.
“The types of products shoplifters are targeting may not be based solely on price point,” the National Retail Federation said.
“Products can range from high-price, high-fashion items to everyday products that have a fast resale capability,” the group said. “While ORC groups have traditionally targeted specific items or types of goods, that list has expanded to new categories like outerwear, batteries, energy drinks, designer footwear and kitchen accessories.”
Charlie McCone has been struggling with the symptoms of long COVID since he was first infected, in March 2020. Most of the time, he is stuck on his couch or in his bed, unable to stand for more than 10 minutes without fatigue, shortness of breath, and other symptoms flaring up. But when I spoke with him on the phone, he seemed cogent and lively. “I can appear completely fine for two hours a day,” he said. No one sees him in the other 22. He can leave the house to go to medical appointments, but normally struggles to walk around the block. He can work at his computer for an hour a day. “It’s hell, but I have no choice,” he said. Like many long-haulers, McCone is duct-taping himself together to live a life—and few see the tape.
McCone knows 12 people in his pre-pandemic circles who now also have long COVID, most of whom confided in him only because “I’ve posted about this for three years, multiple times a week, on Instagram, and they’ve seen me as a resource,” he said. Some are unwilling to go public, because they fear the stigma and disbelief that have dogged long COVID. “People see very little benefit in talking about this condition publicly,” he told me. “They’ll try to hide it for as long as possible.”
I’ve heard similar sentiments from many of the dozens of long-haulers I’ve talked with, and the hundreds more I’ve heard from, since first reporting on long COVID in June 2020. Almost every aspect of long COVID serves to mask its reality from public view. Its bewilderingly diverse symptoms are hard to see and measure. At its worst, it can leave people bed- or housebound, disconnected from the world. And although milder cases allow patients to appear normal on some days, they extract their price later, in private. For these reasons, many people don’t realize just how sick millions of Americans are—and the invisibility created by long COVID’s symptoms is being quickly compounded by our attitude toward them.
Most Americans simply aren’t thinking about COVID with the same acuity they once did; the White House long ago zeroed in on hospitalizations and deaths as the measures to worry most about. And what was once outright denial of long COVID’s existence has morphed into something subtler: a creeping conviction, seeded by academics and journalists and now common on social media, that long COVID is less common and severe than it has been portrayed—a tragedy for a small group of very sick people, but not a cause for societal concern. This line of thinking points to the absence of disability claims, the inconsistency of biochemical signatures, and the relatively small proportion of severe cases as evidence that long COVID has been overblown. “There’s a shift from ‘Is it real?’ to ‘It is real, but …,’” Lekshmi Santhosh, the medical director of a long-COVID clinic at UC San Francisco, told me.
Yet long COVID is a substantial and ongoing crisis—one that affects millions of people. However inconvenient that fact might be to the current “mission accomplished” rhetoric, the accumulated evidence, alongside the experience of long haulers, makes it clear that the coronavirus is still exacting a heavy societal toll.
As it stands, 11 percent of adults who’ve had COVID are currently experiencing symptoms that have lasted for at least three months, according to data collected by the Census Bureau and the CDC through the national Household Pulse Survey. That equates to more than 15 million long-haulers, or 6 percent of the U.S. adult population. And yet, “I run into people daily who say, ‘I don’t know anyone with long COVID,’” says Priya Duggal, an epidemiologist and a co-lead of the Johns Hopkins COVID Long Study. The implication is that the large survey numbers cannot be correct; given how many people have had COVID, we’d surely know if one in 10 of our contacts was persistently unwell.
But many factors make that unlikely. Information about COVID’s acute symptoms was plastered across our public spaces, but there was never an equivalent emphasis that even mild infections can lead to lasting and mercurial symptoms; as such, some people who have long COVID don’t even know what they have. This may be especially true for the low-income, rural, and minority groups that have borne the greatest risks of infection. Lisa McCorkell, a long-hauler who is part of the Patient-Led Research Collaborative, recently attended a virtual meeting of Bay Area community leaders, and “when I described what it is, some people in the chat said, ‘I just realized I might have it.’”
Admitting that you could have a life-altering and long-lasting condition, even to yourself, involves a seismic shift in identity, which some people are understandably loath to make. “Everyone I know got Omicron and got over it, so I really didn’t want to concede that I didn’t survive this successfully,” Jennifer Senior, a friend and fellow staff writer at The Atlantic, who has written about her experience with long COVID, told me. Duggal mentioned an acquaintance who, after a COVID reinfection, can no longer walk the quarter mile to pick her kids up from school, or cook them dinner. But she has turned down Duggal’s offer of an appointment; instead, she is moving across the country for a fresh start. “That is common: I won’t call it ‘long COVID’; I’ll just change everything in my life,” Duggal told me. People who accept the condition privately may still be silent about it publicly. “Disability is often a secret we keep,” Laura Mauldin, a sociologist who studies disability, told me. One in four Americans has a disability; one in 10 has diabetes; two in five have at least two chronic diseases. In a society where health issues are treated with intense privacy, these prevalence statistics, like the one-in-10 figure for long COVID, might also intuitively feel like overestimates.
Some long-haulers are scared to disclose their condition. They might feel ashamed for still being sick, or wary about hearing from yet another loved one or medical professional that there’s nothing wrong with them. Many long-haulers worry that they’ll be perceived as weak or needy, that their friends will stop seeing them, or that employers will treat them unfairly. Such fears are well founded: A British survey of almost 1,000 long-haulers found that 63 percent experienced overt discrimination because of their illness at least “sometimes,” and 34 percent sometimes regretted telling people that they have long COVID. “So many people in my life have reached out and said, ‘I’m experiencing this,’ but they’re not telling the rest of our friends,” McCorkell said.
Imagine that you interact with 50 people on a regular basis, all of whom got COVID. If 10 percent are long-haulers, that’s five people who are persistently sick. Some might not know what long COVID is or might be unwilling to confront it. The others might have every reason to hide their story. “Numbers like 10 percent are not going to naturally present themselves in front of you,” McCone told me. Instead, “you’ll hear from 45 people that they are completely fine.”
Illustration by Paul Spella / The Atlantic; Getty
The same factors that stop people from being public about their condition—ignorance, denial, or concerns about stigma—also make them less likely to file for disability benefits. And that process is, to put it mildly, not easy. Applicants need thorough medical documentation; many long-haulers struggle to find doctors who believe their symptoms are real. Even with the right documents, applicants must hack their way through bureaucratic overgrowth, likely while fighting fatigue or brain fog. For these reasons, attempting to measure long COVID through disability claims is a profoundly flawed exercise. Even if people manage to apply, they face an average wait time of seven months and a two-in-three denial rate. McCone took six weeks to put an application together, and, despite having a lawyer and extensive medical documentation, was denied after one day. McCorkell knows many first-wavers—people who’ve had long COVID since March 2020—“who are just getting their approvals now.”
An alternative source of data comes from the Census Bureau’s Current Population Survey, which simply asks working-age Americans if they have any of six forms of disability. Using that data, Richard Deitz, an economics-research adviser at the Federal Reserve Bank of New York, calculated that about 1.7 million more people now say they do than in mid-2020, reversing a years-long decline. These numbers are lower than expected if one in 10 people who gets COVID really does become a long-hauler, but the survey doesn’t directly capture many of the condition’s most common symptoms, such as fatigue, neurological problems beyond brain fog, and post-exertional malaise, where a patient’s symptoms get dramatically worse after physical or mental exertion. About 900,000 of the newly disabled people are also still working. David Putrino, who leads a long-COVID rehabilitation clinic at Mount Sinai, told me that many of his patients are refused the accommodations required under the Americans With Disabilities Act. Their employers won’t allow them to work remotely or reduce their hours, because, he said, “you look at them and don’t see an obvious disability.”
Long COVID can also seem bafflingly invisible when people look at it with the wrong tools. For example, a 2022 study by National Institutes of Health researchers compared 104 long-haulers with 85 short-term COVID patients and 120 healthy people and found no differences in measures of heart or lung capacities, cognitive tests, or levels of common biomarkers—bloodstream chemicals that might indicate health problems. This study has been repeatedly used as evidence that long COVID might be fictitious or psychosomatic, but in an accompanying editorial, Aluko Hope, the medical director of Oregon Health and Science University’s long-COVID program, noted that the study exactly mirrors what long-haulers commonly experience: They undergo extensive testing that turns up little and are told, “Everything is normal and nothing is wrong.”
The better explanation, Putrino told me, is that “cookie-cutter testing” doesn’t work—a problem that long COVID shares with other neglected complex illnesses, such as myalgic encephalomyelitis/chronic-fatigue syndrome and dysautonomia. For example, the NIH study didn’t consider post-exertional malaise, a cardinal symptom of both ME/CFS and long COVID; measuring it requires performing cardiopulmonary tests on two successive days. Most long-haulers also show spiking heart rates when asked to simply stand against a wall for 10 minutes—a sign of problems with their autonomic nervous system. “These things are there if you know where to look,” Putrino told me. “You need to listen to your patients, hear where the virus is affecting them, and test accordingly.”
Contrary to popular belief, researchers have learned a huge amount about the biochemical basis of long COVID, and have identified several potential biomarkers for the disease. But because long COVID is likely a cluster of overlapping conditions, there might never be a singular blood test that “will tell you if you have long COVID 100 percent of the time,” Putrino said. The best way to grasp the scale of the condition, then, is still to ask people about their symptoms.
Large attempts to do this have been relatively consistent in their findings: The U.S. Household Pulse Survey estimates that one in 10 people who’ve had COVID currently have long COVID; a large Dutch study put that figure at one in eight. The former study also estimated that 6 percent of American adults are long-haulers; a similar British survey by the Office for National Statistics estimated that 3 percent of the general population is. These cases vary widely in severity, and about one in five long-haulers is barely affected by their symptoms—but the remaining majority very much is. Another one in four long-haulers (or 4 million Americans) has symptoms that severely limit their daily activities. The others might, at best, wake every day feeling as if they haven’t had any rest, or feel trapped in an endless hangover. They might work or socialize when their tidal symptoms ebb, but only by making big compromises: “If I work a full day, I can’t also then make dinner or parent without significant suffering,” JD Davids, who has both long COVID and ME/CFS, told me.
Some people do recover. A widely cited Israeli study of 1.9 million people used electronic medical records to show that most lingering COVID symptoms “are resolved within a year from diagnosis,” but such data fail to capture the many long-haulers who give up on the medical system precisely because they aren’t getting better or are done with being disbelieved. Other studies that track groups of long-haulers over time have found less rosy results. A French one found that 85 percent of people who had symptoms two months after their infection were still symptomatic after a year. A Scottish team found that 42 percent of its patients had only partially recovered at 18 months, and 6 percent had not recovered at all. The United Kingdom’s national survey shows that 69 percent of people with long COVID have been dealing with symptoms for at least a year, and 41 percent for at least two.
The most recent data from the U.S. and the U.K. show that the total number of long-haulers has decreased over the past six months, which certainly suggests that people recover in appreciable numbers. But there’s a catch: In the U.K., the number of people who have been sick for more than a year, or who are severely limited by their illness, has gone up. A persistent pool of people is still being pummeled by symptoms—and new long-haulers are still joining the pool. This influx should be slower than ever, because Omicron variantsseem tocarry alower risk of triggering long COVID, while vaccines and the drug Paxlovid can lower that risk even further. But though the odds against getting long COVID are now better, more people are taking a gamble, because preventive precautions have been all but abandoned.
Even if prevalence estimates were a tenth as big, that would still mean more than 1 million Americans are dealing with a chronic illness that they didn’t have three years ago. “When long COVID first came on the scene, everyone told us that once we have the prevalence numbers, we can do something about it,” McCorkell told me. “We got those numbers. Now people say, ‘Well, we don’t believe them. Try again.’”
To a degree, I sympathize with some of the skepticism regarding long COVID, because the condition challenges our typical sense of what counts as solid evidence. Blood tests, electronic medical records, and disability claims all feel like rigorous lines of objective data. Their limitations become obvious only when you consider what the average long-hauler goes through—and those details are often cast aside because they are “anecdotal” and, by implication, unreliable. This attitude is backwards: The patients’ stories are the ground truth against which all other data must be understood. Gaps between the data and the stories don’t immediately invalidate the latter; they just as likely show the holes in the former.
Laura Mauldin, the disability sociologist, argues that the U.S. is primed to discount those experiences because the country’s values—exceptionalism, strength, self-reliance—have created what she calls the myth of the able-bodied public. “We cannot accept that our bodies are fallible, or that disability is utterly ordinary and expected,” she told me. “We go to great pains to pretend as though that is not the case.” If we believe that a disabling illness like long COVID is rare or mild, “we protect ourselves from having to look at it.” And looking away is that much easier because chronic illnesses like long COVID are more likely to affect women—“who are more likely to have their symptoms attributed to psychological problems,” Mauldin said—and because the American emphasis on work ethic devalues people who can’t work as much or as hard as their peers.
Other aspects of long COVID make it hard to grasp. Like other similar, neglected chronic illnesses, it defies a simplistic model of infectious disease in which a pathogen causes a predictable set of easily defined symptoms that alleviate when the bug is destroyed. It challenges our belief in our institutions, because truly contending with what long-haulers go through means acknowledging how poorly the health-care system treats chronically ill patients, how inaccessible social support is to them, and how many callous indignities they suffer at the hands of even those closest to them. Long COVID is a mirror on our society, and the image it reflects is deeply unflattering.
Most of all, long COVID is a huge impediment to the normalization of COVID. It’s an insistent indicator that the pandemic is not actually over; that policies allowing the coronavirus to spread freely still carry a cost; that improvements such as better indoor ventilation are still wanting; that the public emergency may have been lifted but an emergency still exists; and that millions cannot return to pre-pandemic life. “Everyone wants to say goodbye to COVID,” Duggal told me, “and if long COVID keeps existing and people keep talking about it, COVID doesn’t go away.” The people who still live with COVID are being ignored so that everyone else can live with ignoring it.
This article originally misstated the name of the bank where Richard Deitz works.
As the fire at an Indiana plastics-recycling storage facility burned over several days and officials scrambled to calm evacuated residents and measure air quality, larger safety questions emerged across a nation that relies on recycling to help offset the impact of teeming landfills and littered waterways.
Authorities in the eastern part of the state on Sunday finally lifted a dayslong evacuation order after it was determined immediate environmental concerns related to the fire had passed.
But the man-made disaster had already done its part, leaving many wondering if recycling centers — challenging to regulate because they range from small community-led efforts to major industrial facilities — are as safe as Americans think they are?
Public health experts told MarketWatch the nation needs to take a harder look at how we store and dispose of chemicals-heavy plastics in particular, along with other recycled materials that can act as a tinderbox in certain conditions. It may be a wakeup call to the scores of Americans who embrace recycling as one of the longest-tested and straightforward solutions to help the environment. What happens after recyclable materials leave the home can be quite another story, however.
Worker safety in the handling of large recycling machinery remains a priority of the Occupational Safety and Health Administration (OSHA) and other agencies, but less scrutiny may be given to the emissions those workers breathe in, and in the case of the Indiana emergency, what pollution community members near a recycling center may be exposed to.
“Any company, regardless of its intentions, must be held accountable for regulations, not only for the safety of its employees, but for the communities around it,” Dr. Panagis Galiatsatos, a pulmonologist, who is the national spokesperson for the American Lung Association, told MarketWatch.
“This [Indiana crisis] is alarming — a good deed [such as recycling] undone by the consequences of not having sound safety precautions,” said Galiatsatos, who is also an assistant professor at the Johns Hopkins School of Medicine and helps lead community engagement for the Baltimore Breathe Center.
As for the fire in Richmond, Ind., a college town and county seat of about 35,000 people near the Ohio border, the city’s fire chief, Tim Brown, made clear that there were known code violations by the operator of the former factory that had been turned into plastics storage for recycling or resale. This dangerous fire was a matter of “when, not if,” Brown said in the initial hours that the fire, whose origin is not yet known, burned.
The city of Richmond’s official site about the disaster described the fire as initially impacting “two warehouses containing large amounts of chipped, shredded and bulk recycled plastic, [which] caught fire.” The site does offer cleanup help advice.
Brown, the fire chief, reported that just over 13 of the 14 acres which made up the recycling facility’s property had burned, according to nearby Dayton, Ohio, station WDTN. Brown told reporters the six buildings at the site of the fire were full of plastic from “floor to ceiling, wall to wall,” along with several full semi-trailers. He said Sunday that fire fighters would continue to monitor for flare-ups, according to the Associated Press.
Richmond Mayor Dave Snow said the owner of the buildings has ignored citations that dinged his operation for code violations, and the city has continued to go through steps to get the owner to clean up the property, including preventing the operator from taking on additional plastic.
“We just wish the property owner and the business owner would’ve taken this more serious from day one,” Snow said, according to the report out of Dayton, which cited sister station WXIN. “This person has been negligent and irresponsible, and it’s led to putting a lot of people in danger,” the mayor added.
But some environmental groups say lax enforcement puts citizens at risk.
“Indiana is already top in the nation for water and air quality violations, but the consequences are too negligible here for industry to adhere to the laws,” said Susan Thomas, communications director at Just Transition Northwest Indiana, a climate justice group based in the state.
“We need real solutions to the climate crisis, not more false ones that shield chronic polluters from justice,” she said.
The Environmental Protection Agency (EPA) had collected debris samples from the Richmond fire and searched nearby grounds for any debris, which will be sampled for asbestos given the age of the buildings housing the recycling facility. Residents have been warned not to touch or mow over debris until the sample results are available. Testing was also carried out on the Ohio side of the border.
No doubt, the catastrophe had impacted daily life. Wayne County, Ind., health department officials and fire-safety officials told residents to shelter in place and reduce outdoor activity if they even smelled smoke. According to the health department’s help line, symptoms that may be related to breathing smoke include repeated coughing, shortness of breath or difficulty breathing, wheezing, chest tightness or pain, palpitations, nausea or lightheadedness.
Any safer than a landfill?
When a lens on recycling is widened, it comes to light that how facilities handle their plastic and other materials may not involve much more care than that given to chemical-emitting plastic left to break down in a landfill, say the concerned public health officials.
Of the 40 million tons of plastic waste generated in the U.S., only 5%-6%, or about two million tons, is recycled, according to a report conducted by the environmental groups Beyond Plastics and The Last Beach Cleanup. About 85% went to landfills, and 10% was incinerated. The rate of plastic recycling has decreased since 2018, when it was at 8.7%, per the study.
Generally speaking, when plastic particles break down, they gain new physical and chemical properties, increasing the risk they will have a toxic effect on organisms, says the environmental arm of the United Nations. The larger the number of potentially affected species and ecological functions, the more likely it is that toxic effects will occur.
And although the conditions of the Indiana fire differ from those experienced earlier this year when a Norfolk Southern Corp. NSC, +0.30%
freight train carrying hazardous materials in several cars derailed near East Palestine, Ohio, the public’s concern for that event — which also sparked an evacuation after a chemical plume from a controlled burn — spread widely on social media.
Now, add in Richmond. The public, at large, is increasingly wondering if officials are doing their job to prevent such disasters, and whether the full extent of chemical exposure is known.
“This [fire in Indiana] overlaps in a general sense the chemical safety question raised by the Ohio derailment — and it shouldn’t have just been raised by that one event, but that certainly brought it into focus,” said Dr. Peter Orris, chief of occupational and environmental medicine at the University of Illinois – Chicago.
Orris said lasting solutions pushing awareness and safety around the storage and transportation of chemicals and chemical-based plastic must span political differences over the reach of regulation. He recalled a time just after the 9/11 terror attacks when a fresh look at the transportation of toxic chemicals and the storage and shipment of ammonia and other substances that can have nefarious uses in the wrong hands drew support from unusual partners.
“Shortly after 9/11 a rather broad coalition, including environmental interests such as Greenpeace, and consumer groups, with congressional support, alongside Homeland Security all pushed a model bill about where and how you could transport toxic chemicals, especially going through populated areas,” he said. “Dealing with new concerns around chemicals and recycling plastic may require the same breadth of interests.”
Already, the Biden administration has shown the will to target chemical exposure in U.S. water. Earlier this year, the EPA moved to require near-zero levels of perfluoroalkyl and polyfluoroalkyl substances, part of a classification of chemicals known as PFAS, and also called “forever chemicals” due to how long they persist in the environment. Both the chemical companies and their trade groups have pushed their own steps toward reducing risk, they say. Exposure to some of the chemicals has been linked to cancer, liver damage, fertility and thyroid problems, as well as asthma and other health effects.
And, Orris stressed, regulating recycling with a one-size-fits-all approach may not work.
Surprisingly, it can be the smaller recycling facilities that take bigger steps in curbing emissions than their larger counterparts. Orris in recent years reported on efforts of a San Francisco recycling plant that made emissions reduction a priority, including by banning incineration. The same research trip turned up issues with a Los Angeles-area plant, exposing “real problems with its policies and procedures beginning with the neighborhood smell from organic materials to other issues with toxins.”
How can plastic be so dangerous?
Specifically, the chemicals that help fortify plastic for its many uses present their own unique conditions.
As plastic is heated at high temperatures, melted and reformed into small pellets, it emits toxic chemicals and particulate matter, including volatile gases and fly ash, into the air, which pose threats to health and the local environment, says a Human Rights Watch paper, citing environmental engineering research. When plastic is recycled into pellets for future use, its toxic chemical additives are carried over to the new products. Plus, the recycling process can generate new toxic chemicals, like dioxins, if plastics are not heated at a high enough temperature.
There are other concerns. Plastic melting facilities can emit volatile organic compounds (VOCs) and carcinogens, which in higher concentrations can pollute air both inside facilities and in areas near recycling facilities.
“Plastics, the way they burn, put out dangerous toxins. And plastic can create its own unique chemistry even when it comes into interaction with benign chemicals,” said Galiatsatos of Johns Hopkins.
“There are the lung issues from people breathing in these chemicals and the toxins associated with them. But there is more: systemic inflation from breathing in chemicals, and that can lead to heart disease,” he said.
“I wish we would pay the same amount of attention to plastics, their recycling and their disposal, as we do with sewer systems. When was the last time we heard of a waste system-based cholera outbreak in the U.S.?” he asked rhetorically. “Exactly. That we care about. Yet plastics, especially the burning of chemicals, we treat too lightly.”
The federal government on Wednesday hit Amazon.com Inc. with worker-safety related citations and penalties at three more warehouses, two weeks after issuing citations at the company’s warehouses in three different states.
The latest citations are the result of the Occupational Safety and Health Administration’s investigation of Amazon AMZN, +1.96%
warehouses stemming from referrals from the U.S. Attorney’s Office for the Southern District of New York. At all six locations, OSHA investigators cited the company for exposing warehouse workers to a high risk of low back injuries and other musculoskeletal disorders and asked for a multitude of changes and corrections.
“Amazon’s operating methods are creating hazardous work conditions and processes, leading to serious worker injuries,” said OSHA Assistant Secretary Doug Parker in a statement Wednesday. “They need to take these injuries seriously and implement a company-wide strategy to protect their employees from these well-known and preventable hazards.”
The newest citations come from investigations into Amazon warehouses in Aurora, Colo.; Nampa, Idaho; and Castleton, N.Y. At all three sites, OSHA inspectors concluded that workers are suffering from musculoskeletal injuries “as a result of lifting heavy items while attempting to meet pace of work and production quotas,” according to each of the hazard letters that were sent to those warehouses’ operations managers. Those concerns were similar to those raised by OSHA at the three other Amazon warehouses in Florida, Illinois and a different warehouse in New York a couple of weeks ago.
In Aurora and Nampa, inspectors also found evidence that injuries may not have been reported because Amazon’s on-site first-aid clinic “was not staffed appropriately.” In Castleton, staffers at the company’s on-site clinic, known as AmCare, “question whether workers are actually injured, pressure injured workers to work through their injuries, and steer injured workers to Amazon-preferred doctors,” Rita Young, OSHA area director, wrote in the hazard letter.
The penalties associated with the citations at the three sites total $46,875. OSHA also asked Amazon to detail the changes it makes in response, and said the company’s response will determine whether more evaluation is needed. In addition, the agency’s inspectors may do follow-up visits within the next six months.
Just like with the first three citations, Amazon intends to appeal.
“We take the safety and health of our employees very seriously, and we don’t believe the government’s allegations reflect the reality of safety at our sites,” Amazon spokeswoman Kelly Nantel said in an emailed statement.
A company spokeswoman also referred to several safety-related efforts by the company, including its partnership with the National Safety Council; equipment that’s supposed to help reduce the need for twisting, bending and reaching; and “process improvements” designed by Amazon’s robotics team.
In anticipation of Wednesday’s OSHA citations, a group of worker advocates held a virtual news conference Tuesday. Among the panelists was Debbie Berkowitz, a former chief of staff at OSHA and now a fellow at the Kalmanovitz Initiative for Labor and the Working Poor at Georgetown University.
“I want to make it clear to everybody that these OSHA citations are incredibly historic and significant,” Berkowitz said. “Don’t get thrown by the low amount of penalties,” she added, saying the Occupational Safety and Health Act is a “weak law.”
She went on to say that “OSHA really grounded their investigations using doctors, experts, and what to do to mitigate the hazards… They show that Amazon needs to take action.”
Also present on the news conference was Amazon warehouse worker Jennifer Crane, from St. Peters, Mo.
“I’m glad to see OSHA investigate the safety crisis at Amazon,” she said. “The company blames us for getting injured. They push us to work at unrealistic speeds.”
No country has a perfect COVID vaccination rate, even this far into the pandemic, but America’s record is particularly dismal. About a third of Americans—more than a hundred million people—have yet to get their initial shots. You can find anti-vaxxers in every corner of the country. But by far the single group of adults most likely to be unvaccinated is Republicans: 37 percent of Republicans are still unvaccinated or only partially vaccinated, compared with 9 percent of Democrats. Fourteen of the 15 states with the lowest vaccination rates voted for Donald Trump in 2020. (The other is Georgia.)
We know that unvaccinated Americans are more likely to be Republican, that Republicans in positions of power led the movement against COVID vaccination, and that hundreds of thousands of unvaccinated Americans have died preventable deaths from the disease. The Republican Party is unquestionably complicit in the premature deaths of many of its own supporters, a phenomenon that may be without precedent in the history of both American democracy and virology.
Obviously, nothing about being a Republican makes someone inherently anti-vaccine. Many Republicans—in fact, most of them—have gotten their first two shots. But the wildly disproportionate presence of Republicans among the unvaccinated reveals an ugly and counterintuitive aspect of the GOP campaign against vaccination: At every turn, top figures in the party have directly endangered their own constituents. Trump disparaged vaccines while president, even after orchestrating Operation Warp Speed. Other politicians, such as Texas Governor Greg Abbott, made all COVID-vaccine mandates illegal in their state. More recently, Florida Governor Ron DeSantis called for a grand jury to investigate the safety of COVID vaccines. The right-wing media have leaned even harder into vaccine skepticism. On his prime-time Fox News show, Tucker Carlson has regularly questioned the safety of vaccines, inviting guests who have called for the shots to be “withdrawn from the market.”
Breaking down the cost of vaccine hesitancy would be simple if we could draw a causal relationship between Republican leaders’ anti-vaccine messaging and the adoption of those ideas by Americans, and then from those ideas to deaths due to non-vaccination. Unfortunately, we don’t have the data to do so. Individual vaccine skepticism cannot be traced back to a single source, and even if it could, we don’t know exactly who is unvaccinated and what their political affiliations are.
What we do have is a patchwork of estimations and correlations that, taken together, paint a blurry but nevertheless grim picture of how Republican leaders spread the vaccine hesitancy that has killed so many people. We know that as of April 2022, about 318,000 people had died from COVID because they were unvaccinated, according to research from Brown University. And the close association between Republican vaccine hesitancy and higher death rates has beendocumented. One study estimated that by the fall of 2021, vaccine uptake accounted for 10 percent of the totaldifference between Republican and Democratic deaths. But that estimate has changed—and even likely grown—over time.
Partisanship affected outcomes in the pandemic even before we had vaccines. A recent study found that from October 2020 to February 2021, the death rate in Republican-leaning counties was up to three times higher than that of Democratic-leaning counties, likely because of differences in masking and social distancing. Even when vaccines came around, these differences continued, Mauricio Santillana, an epidemiology expert at Northeastern University and a co-author of the study, told me. Follow-up research published in Lancet Regional Health Americas in October looked at deaths from April 2021 to March 2022 and found a 26 percent higher death rate in areas where voters leaned Republican. “There are subsequent and very serious [partisan] patterns with the Delta and Omicron waves, some of which can be explained by vaccination,” Bill Hanage, a co-author of the paper and an epidemiologist at Harvard, told me in an email.
But to understand why Republicans have died at higher rates, you can’t look at vaccine status alone. Congressional districts controlled by a trifecta of Republican leaders—state governor, Senate, and House—had an 11 percent higher death rate, according to the Lancet study. A likely explanation, the authors write, could be that in the post-vaccine era, those leaders chose policies and conveyed public-health messages that made their constituents more likely to die. Although we still can’t say these decisions led to higher death rates, the association alone is jarring.
One of the most compelling studies comes from researchers at Yale, who published their findings as a working paper in November. They link political party and excess-death rate—the percent increase in deaths above pre-COVID levels—among those registered as either Democrats or Republicans, providing a more granular view. They chose to analyze data from Florida and Ohio from before and after vaccines were available. Looking at the period before the vaccine, researchers found a 1.6 percentage-point difference in excess death rate among Republicans and Democrats, with a higher rate among Republicans. But after vaccines became available, that gap widened dramatically to 10.4 percentage points, again with a higher Republican excess death rate. “When we compare individuals who are of the same age, who live in the same county in the same month of the pandemic, there are differences correlated with your political-party affiliation that emerge after vaccines are available,” Jacob Wallace, an assistant professor of public health at Yale who co-authored the paper, told me. “That’s a statement we can confidently make based on the study and we couldn’t before.”
Even with this new research, it is difficult to determine just how many people died as a result of their political views. In the “excess death” study, researchers dealt only with rates of excess death, not actual death-toll numbers. Overall, excess deaths represent a small share of deaths. “On the scale of national registration for both parties,” Wallace said, “we’re talking about relatively small numbers and differences in deaths” when you look at excess death rates alone.
The absolute number of Republican deaths is less important than the fact that they happened needlessly. Vaccines could have saved lives. And yet, the party that describes itself as pro-life campaigned against them. Democrats are not without fault, though. The Biden administration’s COVID blunders are no doubt to blame for some of the nation’s deaths. But on the whole, Democratic leaders have mostly not promoted ideas or enforced policies around COVID that actively chip away at life expectancy. It is a tragedy that the Republican push against basic lifesaving science has cut lives short and continues to do so. The partisan divide in COVID deaths, Hanage said, is just “another example of how the partisan politics of the U.S. has poisoned the well of public health.”
What’s most concerning about all of this is that partisan disparities in death rates were also apparent before COVID. People living in Republican jurisdictions have been at a health disadvantage for more than 20 years. From 2001 to 2019, the death rate in Democratic counties decreased by 22 percent, according to a recent study; in Republican counties, it declined by only 11 percent. In the same time period, the political gap in death rates increased sixfold.
Health outcomes have been diverging at the state level since the ’90s, Steven Woolf, an epidemiologist at Virginia Commonwealth University, told me. Woolf’s worksuggests that over the decades, state policy decisions on health issues such as Medicaid, gun legislation, tobacco taxes, and, indeed, vaccines have likely had a stronger impact on state health trajectories than other factors. COVID’s high Republican death rates are not an isolated phenomenon but a continuation of this trend. As Republican-led states pushed back on lockdowns, the impact on population death rates was observed within weeks, Woolf said.
If the issue is indeed systemic, that doesn’t bode well for the future. Other factors could explain the higher death rate in Republican-leaning places—more poverty, less education, worse socioeconomic conditions—, though Woolf said isn’t convinced that those factors aren’t related to bad state health policy too. In any case, the long-term decline of health in red states indicates that there is an ongoing problem at a high level in Republican-led places, and that something has gone awry. “If you happen to live in certain states, your chances for living a long life are going to be much higher than if you’re an American living in a different state,” Woolf said.
Unfortunately, this trend shows no signs of breaking. The anti-science messaging that fuels such a divide is popular with Republican leaders because it plays so well with their constituents. Far-right crowds cheer for missed vaccine targets and jokes about executing scientific leaders. In an environment where partisanship trumps all—including trying to save people’s lives—such messaging is both politically effective and morally abhorrent. The data, however imperfect, demand a reckoning with the consequences of such a strategy not only during the pandemic but over the past few decades, and in the years to come. But to acknowledge how many Republicans didn’t have to die would mean giving credence to scientific and medical expertise. So long as America remains locked in a poisonous partisan battle in which science is wrongly dismissed as being associated with the left, the death toll will only rise.
Apple Inc. said Sunday that it now expects lower shipments of its high-end iPhone 14 Pro and iPhone 14 Pro Max devices than it did previously, as COVID-19 issues hamper production in China.
“We continue to see strong demand for iPhone 14 Pro and iPhone 14 Pro Max models,” the company announced in a Sunday evening press release. “However, we now expect lower iPhone 14 Pro and iPhone 14 Pro Max shipments than we previously anticipated and customers will experience longer wait times to receive their new products.”
Apple AAPL, -0.19%
acknowledged in its release that COVID-19 issues have “temporarily impacted” production of the devices at the Zhengzhou site that is the “primary” assembly facility for the iPhone 14 Pro and iPhone 14 Pro Max. That facility is currently seeing “significantly reduced” operating capacity.
“We are working closely with our supplier to return to normal production levels while ensuring the health and safety of every worker,” the company added in the release.
“Although Apple earnings were only a week ago, supply shortages at the high end of the market and recent COVID lockdowns in China impacting a Foxconn plant could negatively impact iPhone units in the December quarter,” UBS analyst David Vogt wrote Wednesday, ahead of Apple’s press release. “While we believe iPhone demand tends to not be perishable, a slippage of a couple of million units is possible below our 86 million forecast.”
Every second of every day, oxygen-rich blood is coursing through your brain. Your heart pumps it up through your chest and neck, along tinier and tinier arterial tubes, twisting and turning among the grooves and lobes of gray matter until it reaches the brain cells it’s meant to nourish. But this journey can be interrupted. An artery can get clogged—often by a free-floating, gelatinous clot—which halts the flow of blood. The clog will starve your brain’s cells of oxygen. Within moments, your brain’s tissue will start to die.
This is what happened to John Fetterman in May of this year, when he suffered an ischemic stroke—a type that affects roughly 700,000 people in the United States annually. Five months later, Pennsylvania’s lieutenant governor says he still struggles to process the words that he hears, and sometimes he can’t quite express what he means. For a regular person, these effects would not be newsworthy. Fetterman, though, is a candidate for the U.S. Senate. This week, NBC News’s Dasha Burns said that Fetterman seemed unable to participate in preinterview small talk conducted without closed captioning, but other recent Fetterman interviewers pushed back, saying he’d done just fine when they spoke with him.
Clearly, observers cannot agree about the degree of impairment or disability that Fetterman is experiencing. But this much is certain: His health is a legitimate consideration for the voters he is seeking to represent in Congress. And although Fetterman’s critics are framing his stroke as a liability, the Democrat is hoping that his health challenge makes him a more relatable—and therefore more appealing—candidate. The question is what voters should make of it all.
For most of the summer, Fetterman’s campaign used social media to compensate for the fact that the Democrat was unwell. On Twitter, Fetterman and his team mocked his Republican opponent, Mehmet Oz, for his many mansions and his ham-handed attempts to seem like an ordinary Pennsylvanian. They scored headline after fawningheadline for their snarky social-media strategy. But the candidate himself stayed home, trying to heal.
Fetterman sounds a lot more like his old self now than he did in August, when he first returned to the campaign trail. But he still stumbles in his speech. At a rally I attended outside Philadelphia last weekend, he delivered a few applause lines and phrases that were difficult to understand; occasionally, the audience would answer with tentative claps. After the event, Fetterman did not entertain questions from reporters, and seemed unable to respond all that meaningfully to on-the-fly comments from voters; his wife, Gisele, appeared to be the one leading those interactions. But while Fetterman may not be able to do small talk, he is able to participate in interviews where he can use real-time closed-captioning, a live transcription of questions appearing on his laptop. He’ll use the same tool during the upcoming debate against Oz scheduled for October 25.
That accommodation for someone who’s recently had a stroke is the same sort of allowance that would be made for a Senate candidate who was hearing impaired. Still, it’s reasonable to ask whether Fetterman’s stroke damaged his cognition, his ability to learn and to comprehend language—and how he might function as a senator.
The campaign says that Fetterman has taken two different cognitive tests and scored “in the normal range” on both. (It has released the results of one of those tests.) But the campaign has declined to release Fetterman’s full health records. “John Fetterman is healthy. He also has an auditory-processing challenge that is still lingering from his stroke in May,” Rebecca Katz, a senior adviser to Fetterman, told me. “The only proof you need to know he can do his job is the fact that he’s doing this campaign right now.”
Still, in the absence of those records, we can only observe and guess. The phrase auditory processing is not really a medical diagnosis, Adam de Havenon, an associate professor of neurology at Yale, told me. Instead, Fetterman’s symptoms seem consistent with aphasia, a common stroke effect in which a person loses their ability to comprehend or express spoken words—sometimes both. That doesn’t necessarily indicate severe brain damage. “It’s very possible to just have trouble understanding spoken language or getting words out without any impact on cognition,” de Havenon said. This would certainly seem consistent with Fetterman’s condition, given that he is able to read and respond to closed captioning. Even if Fetterman does have some cognitive impairment, “I don’t think it would be profound, in terms of what he’s doing on a day-to-day basis,” de Havenon said.
So why keep his full health records under wraps? Fetterman’s neuropsychological or aphasia test results might suggest that he is more impaired than he seems. Or maybe those records show a complicated picture—one that would be easily misinterpreted by laypeople or intentionally misconstrued by political opponents. Either way, keeping those records a secret isn’t a great look for a candidate who has suffered a serious health setback on the campaign trail.
Five months after his stroke, Fetterman is still within the poststroke recovery window. Normally, a stroke patient needs about six months for the brain to heal, de Havenon told me, and 12 months for their brain to learn how to compensate for any loss in function. Which means it’s still entirely possible for Fetterman’s apparent aphasia and his neuropsych test results to improve. “I see patients like John very frequently in the emergency department and clinic,” de Havenon said. Otherwise healthy, middle-aged people who have ischemic strokes receive treatment and generally respond quite well—including over the long term.
America’s laws have long been written, at least in part, by the elderly—the word senator actually comes from the Latin for “old man.” The average age in today’s Senate is 64—in other words, when most people are thinking about retiring, America’s senators are just getting going. But historically, some senators have been barely sentient by the end of their career.
In his early 90s, the longest-serving senator in history, Senator Robert Byrd of West Virginia, was delivering halting speeches on the Senate floor. Senator Strom Thurmond of South Carolina, still in office at 100, died a hunched shadow of his former self—although his former self had been an unapologetic segregationist.
Other senators have had health issues in office that made their jobs next to impossible: Senator Carter Glass of Virginia, who had a serious heart condition, didn’t set foot in the chamber for the last four years of his six-year term, Donald Ritchie, a former Senate historian, told me. Democrats needed California Senator Clair Engle’s vote to break the filibuster on the Civil Rights Act, but he was partially paralyzed and unable to speak because of a brain tumor. “All he could do was put his finger up to his eye,” Ritchie said. “They took that as an aye vote.” In our own time, Senator Dianne Feinstein of California is showing signs of age-related impairment: According to recent reporting, she sometimes fails to follow policy conversations or recognize her colleagues.
Several senators have had strokes in office, too, including recently Ben Ray Luján of New Mexico and Chris Van Hollen of Maryland. After Illinois Senator Mark Kirk’s stroke in 2012, aides were hesitant to discuss how he’d changed mentally, according to a National Journal profile. He returned to the chamber a year later, but his health may have played a role in his later loss to Tammy Duckworth.
This is not to compare John Fetterman’s ailment to those of senators past—or to judge the decisions of the lawmakers who have stayed in office past their prime. Butthe Senate is familiar with disability—brought on by age or any number of other factors. It has and will accommodate it. If Fetterman is elected, Ritchie told me, the secretary of the Senate will help organize the tools he’ll need for a committee hearing or floor speeches. Given how manageable these measures are, the Fetterman campaign could be more transparent about what the Democrat’s everyday life as a senator might look like.
None of this can be easy for Fetterman. Less than a year ago, he was discussed by voters and journalists alike with something akin to awe: A 6-foot-8-inch man in a hoodie, with a goatee and tattoos, is not your typical political candidate; despite his relatively privileged upbringing, Fetterman was the straight-talking everyman, the guy with the irreverent vibe. Back then, the biggest question surrounding his campaign was whether he’d show up to the Senate in cargo shorts.
Fetterman may still be all of those things, but now, he is also a man wrestling with an uncooperative brain. And the entire country is watching, making note of his every pause and stammer.
“We are pulling back the curtain on his recovery,” Katz from Fetterman’s campaign told me, “and having worked in the Senate and seen firsthand how many senators cover up their various challenges, I can tell you that this is refreshing for people. He is being very honest about the challenges he’s facing at this moment.”
Even if his campaign could have been more forthcoming earlier about his condition, it is true that Fetterman has found a way of talking about it since he returned to the trail in late summer. Near the beginning of his stump speech, he asks: “How many of you have had your own personal health challenges?” And every time, nearly every hand in the audience goes up.
Last week, I traveled to Bristol to see Fetterman in action. “I’ve had a hemorrhagic stroke, which is worse,” Jeanette Miller from Bristol Township told me with a shrug when I asked her whether Fetterman’s stroke gave her pause. Rob Blatt, a retiree from Feasterville, looked at me blankly when I asked him the same. “I’ve beaten cancer and a whole bunch of other stuff,” he said. “He’s one of us—a working man trying to do the right thing by his family, his community, and his country.”
A younger fan, Eric Bruno from Levittown, told me he’d worked with people who’d had strokes. “Outwardly, it takes a while to come back. But inwardly you’re still the same person,” he said, adding, “I trust the people around him.” Again and again I asked Fetterman’s supporters about his stroke, and they all responded the same way: So what? Fetterman’s point—that knowing what it’s like to go through a major health challenge, to live with a disability, and to navigate the thorny thicket of the American health-care system can be assets for a Senate candidate—seemed to land well with his supporters. If our elected leaders are supposed to represent us, the Democrat seems to be asking, shouldn’t they be representative of us?
Oz has been closing the gap with Fetterman’s slightly higher poll numbers in recent weeks, but this tightening of the race may owe more to the imminence of the election than to sudden doubts about Fetterman’s health. After weighing their options, Pennsylvanians appear to be sorting themselves into their partisan corners; politically, Pennsylvania is very evenly split. Fetterman’s cognitive ability may ultimately weigh less with Keystone State voters than the simple fact that he is a Democrat, not a Republican.
“I will admit, it wasn’t the best speech I’ve ever heard,” Bobby Summers, a local IT manager, told me after the Bristol rally. He stood next to his wife, Lara, and their baby son on the grassy lawn where Fetterman had just been. “I don’t need a golden tongue,” Lara cut in. “I just need someone who gets the job done and breaks the tie.”
Here’s Everything You Need to Know About Dating With STDs
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Newsflash: Your dating life is not over just because you discover that you have an STD (sexually transmitted disease) or STI (sexually transmitted infection). In fact, the CDC estimates that nearly 20 million new sexually transmitted infections occur every year — that’s more than 2 million cases of the three nationally reported STDs (chlamydia, gonorrhea, and syphilis) in the United States alone.
“Most people don’t realize they are at risk for STIs, but the truth is that anyone who’s ever had anal, oral, or vaginal sex is at risk,” says Julia Bennett, the Director of Learning Strategy at Planned Parenthood Federation of America. “In fact, about half of people will have an STI at some point in their life.”
Everyone deserves to have a safe, healthy and pleasurable sex life, and being able to talk about safer sex, getting tested, and the risks of STIs is a really important part feeling empowered. “Talking about that stuff can feel challenging, but the most important thing is that we do talk about it,” notes Bennett.
Below, you’ll find the ins and outs of STD, STIs, and everything in between. Enjoy the free education.
What are STDs and STIs?
STDs and STIs are diseases/infections that are passed from one person to another through intimate physical contact including vaginal, oral, and anal sex. While there are many different types of STIs, the most common ones you’ve probably heard about are HIV, chlamydia, gonorrhea, herpes, and syphilis.
Some are curable bacterial infections (gonorrhea, chlamydia, and syphilis) as long as you seek medical treatment and take the proper regimen of antibiotic medication. “If you have one of these infections, get treated and tested again later if your provider says you need to,” says Bennett. Sometimes, you might have an STI and not even know it, as is often the case with chlamydia, for which symptoms might not appear for months or years.
Other STIs (like herpes and HIV) are viruses that stay in your system forever. For those, you can’t be cured, but you can treat the symptoms, and in many cases, can significantly reduce them or not feel them at all.
For HIV, a retrovirus, the drugs used to treat it are called antiretrovirals (ARV). Although a cure for HIV does not yet exist, ARVs can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to your partner(s) if taken consistently and correctly, according to the HIV.gov website.
Once you have a diagnosis, it’s important to follow your doctor’s plan of care. “Left untreated, STIs like chlamydia and gonorrhea can cause serious health problems like PID, infertility, and potential deadly ectopic pregnancy,” it reads on the CDC website. Plus, without treatment, it’s more likely that you’ll pass the STDs to your partner.
The Right Way to Tell Your Partner That You Have an STD/STI
If you’re currently living with an STD/STI like herpes or HIV, that doesn’t mean you’ll never land a date again. It does mean you have an added layer of responsibility when it comes to being open and honest with new partners.
The first step is to remember that having an STD doesn’t make you dirty or a bad person. “You’re a human who happens to have a health condition,” says Bennett. The best thing you can do to prepare for the conversation is to know your facts, and go into the chat with a calm, positive attitude.
“There are lots of myths out there, so reading up and being ready to answer questions your partner might have can be really helpful,” she adds. Make it clear that you’re telling them because you care about them. As for the right time, ideally, you’ll want to let your potential sex partner know before things get intimate. Before you bring up the subject, it might be a good idea to practice what you’re going to say out loud to yourself or with someone you trust. “This can help you figure out what you want to say so you feel more confident and comfortable,” notes Bennett.
It’s important to be prepared for different kinds of reactions. “Put yourself in your partner’s shoes and think about how you might feel if someone told you,” she says. “It can feel scary but having an open dialogue can also end up bringing people together.”
What if Your Partner Tells You They Have an STD/STI?
First things first: Remember to take a breath. Before you say something that sounds insensitive, this is someone you care about. A great way to start might be: “Thank you for telling me, I appreciate your honesty,” says Bennett. Then you can ask some questions about how they are living with the STD, what treatments help, and what you both can do to prevent it being transmitted.
Most important whenever you’re having the STD talk? “Avoid the blame game. It can be hard to tell or know when you got an STI or who you got it from. Be open, get tested, and get treated as needed,” she notes. If you’re hung up on how to talk to your partner if they have an STD/STI, check out Planned Parenthood’s informative YouTube series on “talking about safer sex, testing, and STDs.”
Having Sex When You or Your Partner Has an STD or STI
Safe sex is always important, but it becomes increasingly vital when you and/or your partner has an STI. Bennett says that condoms and dental dams are the key products that can significantly reduce the risk of transmitting diseases during vaginal, anal, or oral sex. Oh, and don’t forget the lube. “A lot of people don’t realize that lube helps prevent condoms from breaking, and it reduces the chance of skin tears,” she says.
Just as important as using protection during sex is staying on course with your prescribed treatments. Especially in the case of bacterial STIs, finishing out your antibiotics is a must.
If you have genital herpes, you’re just like 1 out of 6 Americans. “It’s really common and is largely a skin condition, but there is a lot of stigma around it in this country,” explains Bennett. The bottom line is you can have herpes and still have a healthy sex life — dating with herpes is totally fine! “There are lots of things you can do to help prevent transmitting, like staying on medications and practicing safe sex,” she adds.
Dating With HIV
An estimated 1.1 million people are living with HIV in the United States. However, thanks to advances in medicine, for many people, the virus is practically undetectable, thus eliminating the risk of transmitting HIV to an HIV-negative partner through sex, says the CDC.
However, for people who are in an ongoing relationship with a partner who has HIV, a doctor may recommend taking Pre-exposure prophylaxis (or “PrEP” medication) for added protection, along with using condoms and other safe sex practices.
Dating With STIs
If you find that it’s hard to meet new partners when you have an STD or STI, just remember you’re not alone. In fact, there are even dating sites and apps that can help connect you with people who also have STDs/STIs. These include:
Positivesingles
The site and app boasts to be the largest herpes and STD dating community. With 15,000 daily active members and counting, informative blogs, and real-life stories, it’s not just about hooking up — it’s also a support and information network. Check out Positivesingles
MPwH
While this app/site is geared for helping those living with herpes find a dating match in their area, it’s also a great place to chat and discuss managing symptoms, dating life, and more. The big key here is that your privacy is 100 percent protected. Check out MPwH
POZ Personals
Brought to you by POZ, the print and online brand for people living with and affected by HIV/AIDS, Personals is the top dating service for people living with HIV or AIDS. Signing up is free, but there is also a premium membership option available. Check out Poz Personals
Just as with other health conditions, it is possible to live a normal life — and date! — after you’ve been diagnosed with an STD or STI. As long as you follow your doctor’s treatment to the letter, maintain open and honest communication with your partners, and take precautions to practice safe sex, you can enjoy dating just as before. Get yourself back out there.
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