Month: April 2022

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Many schools across the US gambled on offering in-person classes in early August, even as their states were still battling uncontrolled spread of Covid-19.

In some of those schools, it hasn’t gone well.

In Georgia’s Cherokee County School District, for example, there have been at least 80 positive cases since August 3, and more than 1,100 students, teachers, and staff have had to quarantine. At the high school in Paulding County School District, which came to national attention after photos of halls crowded with mostly maskless students went viral, several students and staff have tested positive, forcing the school to adopt a hybrid model of in-person and virtual learning. In Atlanta, one second-grader tested positive the day after classes started; the same week, a 7-year-old with no underlying conditions died from the virus.

Scientists have found clear evidence that children, especially those over 12, can and do transmit the virus, though the disease is generally more mild than in adults. This means school outbreaks can be a risk for students, teachers, and the wider community.

While many school districts that reopened are reporting infected students, these initial cases may not have originated in the classroom. “For most of these cases in Georgia, schools weren’t open long enough for the transmission to be coming from within the schools,” says Megan Ranney, an emergency physician and the director for the Center for Digital Health at Brown University, who researches pediatric mental health.

Nevertheless, infected students and staff arriving in the first week of school have already prompted shutdowns and quarantines around the country; in Mississippi, over half of counties have reported Covid-19 cases in teachers, staff, or students.

What’s remarkable is that health experts predicted that cases among young people would surge if schools reopened before community transmission was under control — yet many school districts went ahead anyway. “This is exactly what we’ve been warning about — when you have high levels of Covid in the community, you will have cases showing up in schools, just because people are catching it out in the community,” says Ranney.

And it’s not just kids, teachers, and parents who are then at risk — school outbreaks can fan wider outbreaks in communities. A recent superspreading event in Ohio, for example, found that children between ages 6 and 16 were part of the chain of transmission, passing the virus on to other children and adults.

The World Health Organization recommends that schools open only if fewer than five percent of those tested for the virus over a two-week period are positive. In the US, the cutoff for what is considered “safe” for reopening schools currently varies by state, but they all tend to look at similar factors: Oregon, for example, has said counties must have fewer than 10 cases per 100,000 people for three weeks before in-person classes resume. Arizona calls for less than 100 cases per 100,000, or a two-week decline in cases, as well as meeting other standards like hospital capacity.

For comparison, Georgia has had 189 cases per 100,000 people in the last seven days as of August 16. (You can check your own state’s rates at the Centers for Disease Control and Prevention here.) In Georgia, many schools also reopened despite high positivity rates — the percentage of people being tested for Covid-19 who have a positive result. Georgia’s number of positive tests per 100,000 people were also well above the general threshold that public health experts recommend for in-person activities.

A recent study from the American Academy of Pediatrics and the Children’s Hospital Association found that 97,000 children in the US got Covid-19 in the last two weeks of July— representing a 40 percent increase, or almost one-third of the total number of pediatric cases since the pandemic began. It’s unclear whether this is an increase in actual infections or if more children, who are often asymptomatic, are now being tested as schools reopen.

Since testing overall is still inadequate to control the virus in the US, the CDC says the true incidence of Covid-19 in children is still unknown. But as Tom Frieden, former director of the CDC, recently tweeted, kids between 5 and 17 now have the highest positivity rate of all age groups. “Age groups aren’t an island,” he wrote. “Spread in any group is a risk to all.”

The US Department of Education is not publicly tracking Covid-19 cases in K-12 schools, numbers of students quarantined, deaths, or school closures. That led a Kansas teacher to create a crowdsourced Google spreadsheet using media reports to track positive cases of Covid-19 associated with schools in over 40 states. It shows that more than 2,000 students, faculty, administrators, and staff have tested positive for Covid-19 nationwide since early July, and that teachers have already died in Mississippi, Alabama, and California.

Public health experts at the University of Texas at Austin recently published a report analyzing the likelihood that students and teachers would arrive on the first day of school already infected. They found it largely depends on the size of the school and how prevalent Covid-19 is in that school’s community. Based on data from mid-July, their model suggests that in Texas, a school of 100 individuals in Denton County could expect one to two Covid-19 cases in the first week, while higher rates in Harris County likely make up four cases.

Hidalgo County, which currently has a 17 percent positive test rate, looks worse yet, with two to eight cases predicted. (Racial and economic disparities contribute to these differences; Hidalgo County is 90 percent Latinx and has seen a disproportionate number of Covid-19 cases.) These numbers are constantly changing, but they show that with high-enough levels of community transmission, you can pretty much guarantee that at least one person will go to school infected, potentially exposing others.

In other countries where data on school-linked outbreaks is more readily available, the impacts of reopening schools have been mixed. In Denmark, reopening schools for 2- to 12-year-olds didn’t make the country’s already minimal outbreak worse. But many precautions were taken to limit transmission.

Denmark reopened elementary schools with extensive safety measures in place, like staggered entry time. Students were placed in small groups to reduce interaction, and hotels and libraries were utilized as additional class space. Even so, the rate of infection increased after Danish schools reopened, although not enough to keep total cases from declining.

In Israel, new cases have skyrocketed since schools reopened two months ago, but the country also lifted other distancing measures at the same time, making it harder to tease apart the causes. There are many factors that can make reopening schools safer, like mask-wearing, social distancing, and regular testing, so it’s difficult to directly compare different countries’ school plans.

Still, there’s a definite trend: Countries like Vietnam and New Zealand, which have generally done a good job controlling spread, have successfully reopened schools. Others, with higher community transmission, like Chile, have struggled.

With a new disease, it’s important to look at the totality of the emerging body of research on different age groups, rather than individual study results. For example, a widely cited South Korean study initially reported in July found that adolescents might spread the virus more than adults; an update from the same researchers this week found that some of the teens’ purported transmission was likely due to families actually sharing outside exposure.

Overall, the sum of evidence — including independent studies from the US, Iceland, and Germany — finds older children may be as likely to spread the virus as adults when infected. A recent literature review found that “opening secondary/high schools is likely to contribute to the spread of SARS-CoV-2.” (The same review found that children under age 10 may be less susceptible to infection.)

Another review published in The Lancet highlights that adequate testing and contact tracing are essential to reopening schools. That’s not possible currently in many US states, which are still seeing positivity rates as high as 23 percent, along with extreme delays in test results.

Chethan Sathya, a pediatric surgeon and assistant professor of surgery at the Cohen Children’s Medical Center in New York, says that people seem to be missing the point that having an incomplete picture of how Covid-19 impacts kids is not license to send them back to school to find out. Ranney points out that some states, like New York and her home state of Rhode Island, currently have low test positivity, and so it may be safer to reopen schools in those areas. ”The only possible road to reopening schools is with low rates of community transmission,” she says.

“Emerging data suggests that it’s unsafe to send children and teachers into school buildings, even with safety protocols, if the prevalence of cases in the community is too high,” she says. If schools choose to reopen anyway, she adds, “it’s an ongoing experiment on children and staff.”

Correction: An earlier version of this story stated that Georgia had 2,236 cases per 100,000 people in the last seven days as of August 16. In fact, it has had 2.236 cumulative cases per 100,000 people and 189 cases per 100,000 in the last seven days.

Lois Parshley is a freelance investigative journalist. Follow her Covid-19 reporting on Twitter @loisparshley.


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The man without a name

April 1, 2022 | News | No Comments

Part of the Escape Issue of The Highlight, our home for ambitious stories that explain our world.


Phil Nichols doesn’t get a lot of unannounced visitors at the long-term sober-living house in Cincinnati where he lives. The two US marshals waiting at the door on a March afternoon in 2018 told Nichols they had information for him. And questions. They wore plainclothes —and smiles — and assured Nichols that he wasn’t in trouble.

He invited them in.

It was all very cordial, very polite, very Midwestern. It was early afternoon, the equivalent of morning for Nichols, who doesn’t wake before noon. Although he was surprised by the visit, Nichols didn’t seem unsettled by it. Then the marshals mentioned an address: 1823 Center Street.

Nichols recognized it immediately. It was his grandmother’s address in New Albany, Indiana. That was where his father was raised, and where Nichols spent time as a child.

It was also the address that Joseph Newton Chandler III, a mysterious dead man that the marshals were investigating, had listed on a rental application in Mentor, Ohio. Only Chandler had listed the city as Columbus, and the resident as Mary R. Wilson, his sister.

Neither the woman nor the address existed — at least not in Columbus.

The marshals then showed Nichols pictures of Chandler and asked whether Nichols recognized the man in the photos.

He did.

In one photo, the man is caught unaware. He wears a wide-brimmed hat and pinstripe suit and stands in front of a cluster of balloons.

“That’s my father,” Nichols said. Except the man in the photo wasn’t Joseph Chandler, he told them. He was Robert Ivan Nichols.

The last time Phil Nichols had seen his father was in the early 1960s. He heard from him once after that, when the elder Nichols sent his teenage son a letter. Inside was a single penny.

That was in 1965. The family reported Robert Nichols missing the same year. They never heard from him again.

Phil thought he also might never find out what happened to his father. Then, more than 50 years later, the marshals turned up at his door and told him a story about a dead boy, a stolen identity, a mysterious man, a suicide — and his father.

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In 2002, 76-year-old Joseph Newton Chandler III had been found dead by suicide in his efficiency apartment near Cleveland, Ohio. He had $82,000 in the bank, says US Marshal Pete Elliott, one of the authorities at Phil Nichols’s door that day. In the absence of a will, law enforcement set out to find Chandler’s next of kin. That’s when they discovered the real Chandler had died in 1945 in a traffic accident in Texas on Christmas Day as he and his parents headed to his grandparents’ house in a car loaded with gifts.

Chandler was 8 when he died. Who the Cleveland man was was anyone’s guess.

In 2014, the marshals began comparing the case to unsolved fugitive cases from the 1960s and ’70s. The name change alone was enough for Elliott to suspect the mystery man had committed crimes in addition to identity theft.

“If he’s running away just from his family, typically when we see that, they don’t go to the extent that Joseph Newton — sorry, Robert Nichols — did,” Elliott said in a phone interview.

The dead man in Cleveland had somehow been using Chandler’s identity since 1978. Aside from the familiar street address, which investigators say is not uncommon among impostors, the elder Nichols had done everything he could to erase himself.

Yet there were clues hinting at a darker past, or at least that’s what Elliott believes. Former coworkers in northeast Ohio where the man who went by Joseph Chandler worked on a contract basis as a draftsman and electrical engineer described him as highly intelligent and a loner. They said he kept a suitcase packed and ready to go and would disappear, only to return to work months later. Before he left, he would tell them, “They’re getting close.”

Earlier, in Kentucky and Indiana, when he was still Robert Nichols, he also spoke in code. He told his wife, “I’m leaving you, and one day you’ll know why,” says Elliott. Suspecting something sinister, Elliott dug up cold cases in the area. Nothing matched. The same was true of other cold cases he tried to connect to Nichols. He couldn’t find any evidence, possibly because Nichols knew how to hide it.

“He didn’t want to be found,” says Elliott. “Dead or alive.”

Using genetic genealogy and GEDmatch — the same site used to identify the Golden State Killer in 2018 — the California nonprofit DNA Doe Project finally solved the Nichols mystery. Law enforcement relies on DNA databases that look at only around 20 markers in the genome. The results from databases that get uploaded to GEDmatch (which accepts data from all the various companies creating genetic profiles, such as 23andMe and AncestryDNA) test for 600,000 markers. It’s the difference between being able to identify only siblings and parents and identifying even distant cousins. Genealogists can use the information to build family trees, which is how DNA Doe Project co-founders Colleen Fitzpatrick and Margaret Press located Phil Nichols.

The story made headlines for its oddness. Because Nichols had spent time in California, there were theories he could have been the Zodiac Killer. On Reddit, which is teeming with amateur genealogical and true crime forums, the case attracted the attention of web sleuths. Yet despite its intrigue, it was only one of dozens of cold cases in the past two years that have been solved by combining family tree genealogy with DNA database searches.

DNA Doe Project alone has solved many of them, including that of Lavender Doe, a young woman whose charred body was discovered in Kilgore, Texas, in 2006. Investigators noted her perfect teeth and the purple shirt she was wearing when she was found, earning her the nickname Lavender Doe. The project was able to give her back her real name, Dana Lynn Dodd. It also was able to name Buckskin Girl, a young woman whose body was discovered in Troy, Ohio, in 1981 dressed in a deerskin poncho over jeans and a sweater. That woman was Marcia L. King. She was from Arkansas and was 21 when she was killed.

But similar techniques are also being used to help families find members they never knew they had, unearthing secrets of illegitimacy, suicide, and ethnic background.

Now the historical narrative for families and society at large can no longer be shaped by the destruction of documents and the selective telling of stories, Matthew Stallard and Manchester historian Jerome de Groot wrote in the Journal of Family History in March. And finding those who don’t want to be found, like Robert Ivan Nichols, can also be devastating, as painful secrets once thought irretrievable are exposed. Which has ethicists and genealogists wondering: Who exactly has the right to tell our ancestors’ stories, and who has the right to simply disappear?


Genealogy, or the exploring of family history, was once done by lovely, generous, and cooperative people, says de Groot. But it was a bit dry.

Now, archival genetic material is no longer kept in public institutions with historians; it’s in the hands of private organizations aggregating DNA for their customers. The largest of the databases, AncestryDNA, has the genetic material of 20 million people, says de Groot. He estimates that 23andMe has about 10 million people.

“If you add all the big databases together, you would get 50 to 60 million people,” he says. “By extrapolation, you could probably get the entire world.”

That huge amount of data is now being used to build out family trees and solve mysteries, of both the familial and forensic sort. The internet has only added to the genealogists’ role, enabling them to interact and crowdsource in ways they never could before. On sites like Reddit, they work with more general sleuths to solve mysteries.

“You can basically just put people together and match and not really deal with the consequences,” says de Groot.

The Golden State Killer case marked a huge pivot from using the databases for educational or informational purposes to using them to solve crimes, says Benjamin Berkman, a faculty member in the National Institutes of Health Department of Bioethics with a joint appointment in the National Human Genome Research Institute. But their use has only recently begun to raise ethical questions.

“There’s been a long, robust history of thinking about the ethics of genetics in a medical context, but as these new technologies developed, there hasn’t always been, at least at the outset, the same sort of attention,” says Berkman.

But there are ethical dilemmas to consider, such as the tendency of people to not want to know unpleasant things.

“Knowing that your parent had committed a crime a long time ago, for example, would be traumatic for a lot of people,” says Berkman. “So you are imposing a burden on people by digging around and uncovering stuff that they want to keep hidden.”

Indiana veterinarian turned genealogist Michael Lacopo recently wrote a cautionary chapter about uncovering family secrets in the 2019 book Advanced Genetic Genealogy: Techniques and Case Studies. While Lacopo appreciates the thrill of solving a genealogical puzzle, he also worries about the ramifications.

“I think you lose track of the trail you leave behind you and the ripple effect you have in front of you,” he says.

Fake names, as in the case of Robert Nichols, can be even more troubling. If a person has committed a crime and is fleeing it, that is one thing. But if they are innocent and possibly fleeing an unsafe situation, Berkman says he believes that they “would have a right to not have their past dredged up.”

In the Nichols case, police were looking for relatives of the man they knew only as Joseph Newton Chandler III when they learned he hadn’t taken the name until 1978, the same year he started working in northeast Ohio. Fingerprints were unattainable, and the dead man seemed to have no friends or family. They did have a tissue sample from an earlier hospitalization, and the mystery man’s DNA profile was uploaded to national databases. When nothing turned up, law enforcement in 2016 contacted Colleen Fitzpatrick, half of the two-person forensic genealogy consulting company IdentiFinders International. She tracked down one match, but it ultimately led her nowhere.

It was around this same time that California genealogist Margaret Press approached Fitzpatrick with an idea. Press wanted to form an organization to help identify Jane and John Does using her years of genealogy experience building family trees combined with DNA databases. It was something she and other genealogists had been doing to help adoptees for some time. Together, the women developed data to generate genetic profiles for forensic cases in the same way companies such as 23andMe create genetic profiles for individuals. They then uploaded those profiles to GEDMatch. What they needed were cases. Fitzpatrick thought of Elliott. He agreed to let her have another crack at the mystery suicide case.

Although Nichols’s DNA was very degraded, the women, using techniques they developed, were able to obtain more genetic information than Fitzpatrick originally found, locating a number of third and fourth cousins. With the help of volunteers, they built family trees, narrowing their search to a single family with four sons. There were death certificates for three, but there was no death certificate for one of them — Robert Ivan Nichols. A volunteer looked up his birth certificate. He recognized the address it listed: 1823 Center Street.


New Albany, Indiana — that’s where it all began for the family. A suburb of Louisville, just across the Ohio River in Kentucky, is where Robert Ivan Nichols returned after fighting in World War II. Robert got a job delivering Coca-Cola, and played standup bass in a “hillbilly” band, Phil Nichols says. Phil’s maternal grandfather was a farmer who called square dances. Robert met Phil’s mother, Laverne Agnus Korty, at a dance.

Robert never talked about the war, but Robert’s mother did. He joined the Navy in 1944, straight out of high school. In May 1945, six Japanese kamikaze planes attacked the ship he was serving on in the South Pacific. He was part of a 16-man team that fed ammunition to one of the ship’s armored guns or turrets. Robert was one of only four men on his turret to survive the attack. In a newspaper account published in the Courier-Journal New Albany Bureau, he describes it as “52 minutes of hell.”

“When it was all over, all I thought about was home,” Robert told the newspaper.

He was 18. The newspaper listed his home address: 1823 Center Street.

When Robert returned to Center Street from the war, Phil’s grandmother told Phil, he put his uniform in the coal bin and burned it. Then Robert got the wooden airplanes he had built as a child and took them outside. He aimed a model machine gun at them.

Rat-a-tat-tat.

The model airplanes were destroyed by the gun’s BBs. That’s what Phil remembers his grandmother telling him. As children, Phil and his two younger brothers, Charlie and Dave, often spent time with their grandparents. It was one of his brothers who found the newspaper article about their father’s ship. Dave, the youngest, died of cancer in 2015; he was 9 when his father disappeared. Phil was 16 and Charlie was 14.

In 2018, after the marshals identified their mystery suicide as Robert Nichols, media accounts followed. Several accounts described how Robert burned his military uniform after returning from the war. Phil was upset that some commenters misinterpreted that as Robert being unpatriotic.

He wants to make it clear that his father was a patriot, but that after the war, he became a pacifist. Robert returned with a Purple Heart and shrapnel in his back and hip. At home, he was quiet and well mannered, rarely showing either affection or anger.

“Even when he was home, it was like nobody was there,” says Phil.

According to Phil, about a year before he left, Robert began encouraging his wife to get a driver’s license and a job. They separated and filed for divorce. Robert asked Phil if he wanted to come with him. Phil told him he didn’t, but not in quite such polite terms. Instead, Phil enlisted in the military after he graduated from high school. His goal was to be a pilot, but he spent most of his off-duty hours in a bar. He wonders now how his life might have been different had he left with his father.

The last message Phil received was the penny, mailed to him while he was stationed in Mississippi. It arrived in a business-size envelope with a California postmark. But there was no letter offering an explanation, nor a return address.

“There was nothing,” he says.

Robert’s letters to his parents, shared with Vox by Elliott, were more prolific. After leaving Louisville, Robert moved to Dearborn, Michigan. In August 1964, he told his parents about going to church in the hope of meeting “the right kind of people.”

“I thaught (sic) it would be a good time to start again since my moving up here was sort of a new beginning,” he wrote.

A year later, he sent them a letter from California.

“I will write as often as I can and let you know how I am doing,” he said. It was his last letter.

Other correspondence came instead — letters from all the organizations Robert’s mother contacted asking for help locating him. A woman named Pauline at the Salvation Army was sympathetic but firm in her 1966 reply, explaining that the organization could not help when the person does not want to be found.

“It’s so hard to understand why so many leave home and neglect to keep in touch …” she wrote.


There were many of those, especially at the turn of the 20th century, says Franchesca Werden, DNA Doe Project’s media director. Before the internet and DNA, it was relatively common and easy for people to disappear. That happened a lot, says Werden. A man could move four towns over and change his name, or not change his name, and just lead another life. In the 19th century, taking on an alias was relatively simple, wrote Beverly Schwartzberg in the Journal of Social History in 2004. Schwartzberg cited a song popular among California miners, the refrain of which is: “Oh, what was your name in the States?”

That doesn’t mean it did not have a profound effect on the families left behind. In her genealogical research, Werden has found that what happened generations ago is woven into the tapestry of a family’s story. A father who walked out in 1939 to buy a pack of cigarettes and never came back has an impact on his grandchildren. How exactly this plays out differs from family to family. It’s “sort of Tolstoy,” with each family suffering a unique sort of grief, says Margaret Press, the DNA Doe co-founder, who happens to write her own true crime and mystery books.

Before co-founding the DNA Doe Project with Fitzpatrick in 2017, Press worked on finding parentage in adoption cases. (Fitzpatrick left in June to spend more time on IdentiFinders.) Both in adoption and in Jane and John Doe searches, the ethical questions are the same, says Press, including “whose rights trumps whose.” In the case of adoption, the primary question is whether an adoptee’s right to know their history trumps a birth parent’s right to privacy. Press believes it does. Although she finds it “sad” that sperm donors and birth parents may have been promised that they would never be named, she says she believes “anonymity is not a right.”

There are times she is less sure of herself. She acknowledges “there’s conflicting moral rights,” and that without the benefit of a law, the DNA Doe Project has to make its own ethical decisions. Press is firm in her belief that families have the right to know and authorities have the right to close cases, but she points out that the Doe Project only makes recommendations based on its findings and leaves it to law enforcement to decide about notifying families. Yet the project often contacts distant family members to narrow down their search. Press recalls accidentally contacting a first instead of third cousin.

“And I kind of stepped on a snake, if you will,” she says. “I overturned a bucket I didn’t expect to overturn.”

Press also cites the case of an African American man who discovered his birth father was a white man who had a wife, two grown children, and a country club membership. After the father rebuffed his son, Press wondered if she should tell the half-siblings about their half-brother. Someone else asked whether the father had the right not to know.

“And I thought that was an interesting semantic twist,” says Press. “Do people have a right not to know? And how do we make that decision for them?”

In some ways, it is easier to make decisions in Doe cases because the person at the center of the mystery is dead. In other ways, it is more complicated. In the 30 cases the project has solved, Press says mental illness and family estrangement are common. In many cases, the families never declared the Does missing, says Fitzpatrick. It could be because of the estrangement, or lack of support from police, or even lack of power to conduct a national search, which was true when some of these cases occurred more than 30 years ago. Law enforcement officials were limited by technology and their own biases, and some families might not have seen any reason to involve them, says Press. While online sleuths sometimes fault families for not reporting the member missing, she sees it differently.

“Yes, there were families where the mother was in jail or didn’t care or didn’t seem to care. We don’t know how they really feel,” she says.

Yet she and others doing this sort of work generally operate under the assumption that the family must want to know. It gets more complicated when suicide and fake names are involved. Fitzpatrick remembers one case involving a woman who appeared to have fled her original family. The woman, who went by the name Lori Erica Ruff, killed herself in Texas in 2010. Afterward, it was discovered that she had been using an alias. Her true identity was revealed in 2016. She left home in Philadelphia in 1986 at 17 because she did not get along with her stepfather. Did she have an obligation to let the family know when she apparently didn’t want to be found? Fitzpatrick wonders. In some ways the question is moot; DNA and genealogists are already in play.

Investigative journalist James Renner, who reported on the Chandler case and even wrote a novel loosely based on it, believes Ruff and those like her who are running from something terrible should be able to disappear.

“What right do we have to open up those doors?” he asks.

He makes an exception for rape and murder, and he is not the only one who believes the Nichols case may have involved both. Because of Robert Nichols’s various eccentricities and the time he spent in California in the late 1960s and early ’70s, when the Zodiac Killer was active there, some web sleuths and even members of law enforcement — like Elliott, who says he can’t rule it out — suspect Nichols could be the killer. Phil is less sure.

“I find it hard to imagine because he was always such a gentle person,” he says.

Instead, he thinks his father was running from responsibility, in particular paying child support. When reporters come asking about the case, he is polite and open yet protective of other family members. He has the introspection and patience of a man who has spent years in Alcoholics Anonymous. He is reluctant to criticize or dwell on what he cannot change. But he does ask what the family gets out of it. The press gets a story, law enforcement gets to close a case, the Doe Project gets congratulations, but what does the family get?

His dad is still missing, in ways. All Phil knows now is how he died. Little was left in his apartment aside from the gun he used to kill himself. Elliott offered it to Phil and his brother. They told him to keep it. Of the press conference where his father’s identity was announced, Phil says, “I was just a minor part of it.” He is one of the few family members who have spoken publicly. While Press doesn’t think Does have a right to privacy, she believes their families do. Yet the work she does can lead to their exposure.

Without guidelines and rules, genetic genealogy is a sort of a Wild West, says Renner.

“Not that DNA databases are new,” adds de Groot. “It’s just that suddenly there’s this enormous ability for amateurs to get involved, and that opens up all kinds of ethical issues.”

Fitzpatrick wants to try to address some of those issues through a think tank that will bring together prosecutors, law enforcement, genealogists, missing persons experts, database engineers, and family members. (GEDMatch changed its policy earlier this year so users now have to opt in to allow law enforcement access to their data.)

“We are past the ‘oh, my god’ era,” says Fitzpatrick.

Now, she says, we have to address where we are going with it.

The Nichols case was one of the first “oh, my god” tales. If it were a Hollywood script, it might end with Robert being the Zodiac Killer, says Renner. But Robert also could have been a Don Draper, who on the television show Mad Men lives a double life after being traumatized by war.

“So, which is it?” asks Renner.

Elliott, the US marshal, says he is still trying to figure it out. Phil may never know. He is 72 and haunted by his own ghosts. After he was discharged from the military, Phil held a series of jobs: in printing, driving trucks, with various temp agencies. He’s been married four times and has five children. The women and children are not really part of his life anymore, aside from one daughter who lives in Louisville. Over the years, he’s moved many times. Somewhere along the way, he lost his father’s Purple Heart. He also lost any pictures he had of them together.

In the single room where he lives in Cincinnati, about 100 miles northeast of Louisville, he keeps several pictures of his father on his computer. Some are labeled “Dad as Joseph Newton Chandler,” and others are from when his father was Robert Nichols. There are a coffeepot and microwave in the room and a deck where he can smoke. He has lived in long-term sober living homes for almost two decades. His earlier life was spent largely in the haze of alcohol and drug addiction.

The $82,000 his father left behind would have been useful. Some of the money was spent on private investigators, and some went to the coworker who served as executor. All of it is gone. Before he killed himself, Robert Nichols had been diagnosed with colon cancer and was undergoing treatment. He was nearing the end of his life and, living in the Midwest again, he had almost come home. His last stop was Cleveland, a city just four hours from where his eldest son was living and a little over five from his original home on Center Street in Indiana.

Phil never got to tell his father he forgives him for leaving — and for not really being there in the first place. He has never visited the graveyard in Cleveland where his father’s ashes are interred. He doesn’t believe that’s where his father is. Not his soul, at least.

In a way, he is right. The name on the wall where his father’s remains rest is that of another man: Joseph Newton Chandler III.

Katya Cengel has written for the New York Times Magazine and the Wall Street Journal, among other publications, and is the author of three nonfiction books. Her most recent book, From Chernobyl with Love: Reporting from the Ruins of the Soviet Union was awarded an Independent Publisher Book Award and a Foreword INDIES.


Will you become our 20,000th supporter? When the economy took a downturn in the spring and we started asking readers for financial contributions, we weren’t sure how it would go. Today, we’re humbled to say that nearly 20,000 people have chipped in. The reason is both lovely and surprising: Readers told us that they contribute both because they value explanation and because they value that other people can access it, too. We have always believed that explanatory journalism is vital for a functioning democracy. That’s never been more important than today, during a public health crisis, racial justice protests, a recession, and a presidential election. But our distinctive explanatory journalism is expensive, and advertising alone won’t let us keep creating it at the quality and volume this moment requires. Your financial contribution will not constitute a donation, but it will help keep Vox free for all. Contribute today from as little as $3.

In the past half-century, the global production of meat has undergone a seismic shift. While meat was once mostly raised on small farms, today almost all the meat we eat comes from industrialized “factory” farms, known as “concentrated animal feeding operations,” or CAFOs. More than 90 percent of the world’s meat supply comes from CAFOs. And in the US, that figure is closer to 99 percent.

Animals in CAFOs are often packed closely together, which makes the facilities efficient and, for many, ethically dubious. There are also environmental concerns around these industrial farms. But infectious disease experts worry about CAFOs for a different reason: They’re an ideal environment for virus and bacteria mutations that human immune systems have never seen. In other words, they’re a highly likely source for the next pandemic.

Watch the video above to learn how humans have created the ideal environment for pandemic-causing pathogens.

You can find this video and all of Vox’s videos on YouTube. And if you’re interested in supporting our video journalism, you can become a member of the Vox Video Lab on YouTube.


Will you become our 20,000th supporter? When the economy took a downturn in the spring and we started asking readers for financial contributions, we weren’t sure how it would go. Today, we’re humbled to say that nearly 20,000 people have chipped in. The reason is both lovely and surprising: Readers told us that they contribute both because they value explanation and because they value that other people can access it, too. We have always believed that explanatory journalism is vital for a functioning democracy. That’s never been more important than today, during a public health crisis, racial justice protests, a recession, and a presidential election. But our distinctive explanatory journalism is expensive, and advertising alone won’t let us keep creating it at the quality and volume this moment requires. Your financial contribution will not constitute a donation, but it will help keep Vox free for all. Contribute today from as little as $3.

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Remember Sharpiegate?

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It turns out that the National Oceanic and Atmospheric Administration (NOAA) may still be reeling from that episode, when President Trump’s refusal to admit he was wrong ballooned into an actual scandal at one of the nation’s premier scientific institutions.

The New York Times reported this week that NOAA’s acting chief scientist, Craig McLean, who called out political interference during the ordeal, was removed from his post this month when he asked a new political appointee to acknowledge the agency’s scientific integrity guidelines. The guidelines prohibit manipulating scientific research for political ends.

The appointee, Erik Noble, a former White House adviser, was not pleased, according to the Times:

The request prompted a sharp response from Dr. Noble. “Respectfully, by what authority are you sending this to me?” he wrote, according to a person who received a copy of the exchange after it was circulated within NOAA.

Mr. McLean answered that his role as acting chief scientist made him responsible for ensuring that the agency’s rules on scientific integrity were followed.

The following morning, Dr. Noble responded. “You no longer serve as the acting chief scientist for NOAA,” he informed Mr. McLean, adding that a new chief scientist had already been appointed. “Thank you for your service.”

McLean is still at NOAA, but he’s been replaced as chief scientist by Ryan Maue, a former research meteorologist at the Cato Institute.

It makes sense that scientific integrity was front of mind for McLean when dealing with a political appointee. NOAA in general and McLean in particular have been forced to police the line between science and politics ever since Hurricane Dorian in 2019 galloped toward the Gulf Coast. Trump tweeted at the time that Alabama was one of several states “most likely” to be struck. The National Weather Service’s Birmingham, Alabama, office quickly responded that the state was emphatically not in the path of the storm.

A few days later, McLean defended NOAA’s scientists, including researchers at the National Weather Service, and openly decried the interference from the White House in a statement.

It’s rare for a career employee at a government agency to publicly challenge political staff, which may be why a White House appointee at NOAA was so keen to remove him. And while the whole affair may seem silly, it has consequences beyond bruising the president’s ego.

Political interference, or even the appearance thereof, undermines the credibility of an agency like NOAA whose research is used to make life-or-death decisions, like who needs to get out of the path of a dangerous storm.

Now, even before an election, just as Hurricane Zeta, the 27th named storm of the Atlantic hurricane season, has left 2 million without power along the Gulf Coast, political staff are sidelining scientists at an agency tasked with staying ahead of natural disasters. And it’s likely more manipulation of science is in store if Trump wins a second term in office.

The Trump administration’s repeated attacks on scientific agencies weaken public trust

When his words didn’t match reality, President Trump tried to make reality match his words.

He responded with multiple tweets defending his statement that Alabama was in the path of Hurricane Dorian. He pressured his Homeland Security adviser to release a statement validating him. NOAA, the parent agency of the National Weather Service, issued a curt statement downplaying comments from its Birmingham station. Then, in the Oval Office, President Trump infamously presented a map of Hurricane Dorian’s path, but the forecast was doctored with a black line to include Alabama.

Altering an official weather forecast is actually illegal for a government employee, though it’s not clear who actually drew the black line on the map (it’s not clear whether it was drawn with a Sharpie, either).

In a September 10, 2019, statement, McLean criticized the decision to use NOAA’s press office to echo Trump and undercut the National Weather Service. “My understanding is that this intervention to contradict the forecaster was not based on science but on external factors including reputation and appearance, or simply put, political,” he wrote. “If the public cannot trust our information, or we debase our forecaster’s warnings and products, that specific danger arises.”

The inspector general of the US Department of Commerce, which oversees NOAA, agreed. A report from the inspector general this summer found that NOAA’s credibility “took a serious hit” when top officials at the agency contradicted the National Weather Service’s Birmingham office:

The Statement undercut the NWS’s forecasts and potentially undercut public trust in NOAA’s and the NWS’s science and the apolitical nature of that science. By requiring NOAA to issue an unattributed statement related to a then-5-day-old tweet, while an active hurricane continued to exist off the east coast of the United States, the Department displayed poor judgment in exercising its authority over NOAA.

But the political pressure on NOAA was mounting before Sharpiegate and has been aimed at influencing the science that drives policy, particularly around climate change.

Since Trump took office, NOAA has not had a Senate-confirmed leader. Currently, Neil Jacobs, the acting Under Secretary of Commerce for Oceans and Atmosphere, is serving as NOAA’s interim administrator. Meanwhile, Trump has repeatedly made his disdain for climate change science clear. Shortly after taking office, federal agencies began removing references to climate change from their websites.

For the most part, scientists at NOAA continued doing their jobs but have collided with the White House at times. NOAA is one of the contributing agencies to the National Climate Assessment, a report mandated by Congress to assess the impacts of climate change on the United States. After the last installment highlighted the economic costs of climate change, Trump said he didn’t believe the findings — likely because they undermined his administration’s policies to boost fossil fuels and relax greenhouse gas restrictions.

Since the report is foundational to how the government plans for the future, the Trump administration is aiming to alter it during a second term by “removing longtime authors of the climate assessment and adding new ones who challenge the degree to which warming is occurring, the extent to which it is caused by human activities and the danger it poses to human health, national security and the economy,” according to the New York Times.

The Trump administration has already pursued a similar tack at the Environmental Protection Agency. The EPA ousted numerous independent scientific advisers and instead brought in researchers from the industries it’s supposed to regulate. The agency also placed additional restrictions on what kinds of research could be used to develop environmental regulations, making it easier to roll back restrictions and harder to come up with new rules to govern hazards to air, water, and soil.

And now we’re also seeing this manipulation play out in the Covid-19 pandemic. The White House has repeatedly interfered with and undermined guidance from public health agencies like the Centers for Disease Control and Prevention. Because Trump talked them up, the FDA granted emergency use authorizations to therapies like hydroxychloroquine and convalescent plasma despite weak evidence for their effectiveness.

The net result of all this manipulation is a loss of public trust, making it less likely that people will adhere to guidelines to protect them from disease or environmental dangers. And with the science itself being twisted to meet political ends, dirtier air and water due to weaker regulations, communities left more vulnerable in a disaster, as well as unready and risky approaches being deployed to deal with the Covid-19 pandemic may result.

The US rollout of Johnson & Johnson’s single-dose Covid-19 vaccine was halted Tuesday as regulators race to investigate rare blood-clotting complications linked to the shot. The move may force thousands of people scheduled to receive the shot this week to scramble for an alternative.

Both the Food and Drug Administration and the Centers for Disease Control and Prevention recommended a pause in distributing the vaccine after six reported cases of cerebral venous sinus thrombosis (CVST). These clots block blood flowing out of the brain and can quickly turn deadly.

The complications were found in women between the ages of 18 and 48, and they arose between six and 13 days after receiving the Johnson & Johnson vaccine. “Of the clots seen in the United States, one case was fatal, and one patient is in critical condition,” said Peter Marks, the head of the FDA’s Center for Biologics Evaluation and Research, during a Tuesday press conference.

However, the fact that so few cases led to a nationwide pause of the vaccine has raised questions about a possible overreaction.

Speaking at the White House on Tuesday, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, argued that the CDC and FDA were acting “out of an abundance of caution” and emphasized that their Tuesday decision was a “pause,” implying that it is meant to be temporary.

“I don’t think that they were pulling the trigger too quickly,” Fauci said.

But the move has nonetheless created confusion for people slated to receive the Johnson & Johnson shot and raised fears that it could fuel hesitancy around Covid-19 vaccines.

Johnson & Johnson itself was already reeling from a manufacturing error at one of its suppliers that ruined 15 million doses. And in Colorado, three mass vaccination sites stopped administering the Johnson & Johnson vaccine last week after 11 people reported feelings of nausea and dizziness.

For regulators, the episode highlights the tricky challenge of balancing caution against an urgent need for a vaccine in a still-raging pandemic. And as they investigate the problem, they also have to try to maintain public confidence in the vaccination program. The pause helps show that regulators are taking potential problems seriously, but if they botch the messaging, that could make people less likely to get vaccinated.

What is cerebral venous sinus thrombosis and how is it connected to Johnson & Johnson’s Covid-19 vaccine?

Cerebral venous sinus thrombosis is a condition that blocks blood from leaving the brain. In the general population, it occurs in about five out of a million people. Symptoms of CVST include headache, blurred vision, seizures, and a loss of control of the body.

However, there are several factors that made regulators pay close attention to the recent cases following vaccinations with the Johnson & Johnson shot. Marks explained that patients with these clots also had thrombocytopenia, a condition where platelets in the blood drop to very low levels, leading to bleeding and bruising. The combination of blood clots and low platelets means that patients cannot receive conventional blood clot therapies like heparin, a blood thinner. That’s why health officials want to wait to resume vaccinations with the Johnson & Johnson vaccine until they can investigate the concern and come up with new guidelines if necessary.

Another factor is that these cases occurred in younger women, who normally don’t face a high risk of these types of clots.

The pause of the Johnson & Johnson vaccine mirrors a similar halt in Europe of another Covid-19 vaccine, one developed by the University of Oxford and AstraZeneca, because of concerns about blood clots. In March, the European Union’s pharmaceutical regulator halted the AstraZeneca/Oxford vaccine before allowing distribution to resume. Regulators concluded the vaccine didn’t cause an increase in overall risk of blood clots.

“This is a safe and effective vaccine. Its benefits in protecting people from Covid-19 with the associated risks of deaths and hospitalizations outweigh the possible risks,” said Emer Cooke, executive director of the European Medicines Agency, during a press conference last month.

Both the AstraZeneca/Oxford vaccine and the Johnson & Johnson vaccine are based on a modified adenovirus vector. The adenovirus is a separate virus engineered to deliver DNA instructions to cells for making the spike protein of SARS-CoV-2, the virus that causes Covid-19. Nearly 7 million people in the US have already received the Johnson & Johnson vaccine. The AstraZeneca/Oxford vaccine is still under review and has not begun distribution in the US, although the US government has already purchased millions of doses.

The mechanism connecting these vaccines to CVST isn’t clear just yet, but there are some hypotheses.

Robert Brodsky, director of the hematology division at Johns Hopkins University, said last month that the spike proteins built using the instructions from these vaccines could, in rare cases, trigger an immune system response that interferes with the regulation of blood clots. That immune response could also damage platelets, accounting for the symptoms presented. More evidence is needed to verify that is causing the problem, but it could help scientists develop ways to treat or prevent the issue.

But if a spike protein can trigger this reaction, then it’s likely that a whole intact virus could also trigger CVST in people who are vulnerable. The question is how best to protect those individuals from infection while also mitigating the risks of complications.

Rare complications with Covid-19 vaccines pose a massive challenge for public health messaging

It’s always tricky to communicate risk, but having to study and explain uncommon problems with vaccines was foreseeable. The Covid-19 vaccines were tested in tens of thousands of people in clinical trials, and all three that have begun distribution in the US — from Moderna, Pfizer/BioNTech, and Johnson & Johnson — were shown to be safe, with mild to moderate side effects.

But when vaccines make the jump from thousands of carefully screened trial participants to millions of people in the general population, rare problems — the one-in-a-million complications — start to emerge.

That already happened with the Pfizer/BioNTech vaccine after it started to roll out. Several recipients suffered severe allergic reactions to the vaccine. Similar problems emerged with the Moderna vaccine. The CDC estimated in January that the rate of allergic reactions to the Pfizer/BioNTech Covid-19 vaccine was 11.1 per million vaccinations, while the rate was 2.5 per million for Moderna. Both the Pfizer/BioNTech and the Moderna vaccine use mRNA as their means to deliver instructions to cells for making viral spike proteins. That mRNA is encased in a lipid nanoparticle, which may be what’s triggering the allergic reactions.

While researchers are still investigating the connection, the mRNA vaccines have continued distribution. Health officials modified the vaccine protocol to screen people with a history of severe allergies. They also added a 15-minute waiting period for recipients post-vaccination, since most allergic reactions arose in that window.

Regulators could, then, take a similar approach with the Johnson & Johnson shot to the one they used for allergies and the mRNA vaccines, adding a screening criterion for people at highest risk of these blood clots before they receive the Johnson & Johnson vaccine.

It’s too soon to say whether regulators did everything right when it comes to handling the pause and the public messaging around the vaccine. The willingness to wait and study potential problems may boost overall confidence in vaccinations, or the confusion and fears around complications could make more people wary. Or it may end up as a minor bump in the vaccine rollout.

And what about people who have already received the Johnson & Johnson vaccine?

Fauci said that for people who received the vaccine more than a month ago, they’re out of the woods. But people who have had the shot more recently and start to experience symptoms associated with CVST should alert their physician about their vaccination record.

“If you look at the time frame where this occurs, it’s pretty tight, from six to 13 days from the time of the vaccination,” Fauci said.

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Most people who get the coronavirus will fully recover and go right back to their lives. But the latest research suggests that at least 10 percent have long-term symptoms, even after their body has apparently cleared the virus.

The condition, known as “long Covid,” has emerged as a scary feature of the pandemic — a reminder that even as hospitalizations and deaths come down, millions of people will continue to suffer from the aftermath of infection.

And, as it turns out, “this isn’t unique to Covid,” Akiko Iwasaki, an immunologist at the Yale School of Medicine, told Vox.

Instead, Covid-19 appears to be one of many infections, from Ebola to strep throat, that can give rise to stubborn symptoms in an unlucky subset of patients. “It is more typical than not that a virus infection leads to long-lasting symptoms in some fraction of individuals,” Iwasaki said.

The difference now is that, with 137 million Covid-19 cases worldwide and counting, long-haulers are more visible: Their suffering has come on in unprecedented numbers. It’s also possible the coronavirus causes long-term symptoms even more frequently than other infections.

In this week’s episode of Unexplainable, we dive into what we know about long Covid and what other viruses can teach us about the condition, including the leading hypotheses for what might be driving symptoms in Covid long-haulers.

We also look at what we can learn from patients who have been grappling with medically unexplained symptoms — the kind that don’t correspond to problematic diagnostic test results or imaging — for years before the pandemic hit. Here’s a rundown of what scientists think could explain the mysterious symptoms, and why even the vaccine might not help.

1) The virus and “viral ghosts” didn’t actually leave the body

The first explanation for what might cause persistent symptoms in people who’ve been infected with Covid-19 is the simplest: The virus or its components might still be lurking in the body somewhere, long after a person starts testing negative.

We’ve learned from other long-term viral illnesses that, in some cases, pathogens do not fully clear the body. “It’s out of the blood but gets into tissue in a low level — the gut, even maybe the brain in some people who are really sick — and you have a reservoir of the virus that remains,” PolyBio Research Foundation microbiologist Amy Proal told Vox. “And that drives a lot of inflammation and symptoms.”

These viral reservoirs have been documented following infections with many other pathogens. During the 2014-2016 Ebola epidemic, studies emerged showing the Ebola virus could linger in the eye and semen. There were similar findings during the 2015-2016 Zika epidemic when health officials warned about the possibility that Zika could be sexually transmitted. (Viral reservoirs are also why the moniker “post-viral” can be problematic, Proal added.)

A related explanation for what might be happening with long-Covid patients is what Iwasaki calls “viral ghosts.” While the intact virus may have left the body, “there may be RNA and protein from the virus that’s lingering and continuing to stimulate the immune system,” Iwasaki said. “It’s almost like having a chronic viral infection — it keeps stimulating the immune system because the virus or viral components are still there, and the body doesn’t know how to shut it off.”

Recent studies in Nature and The Lancet documented coronavirus RNA and protein in a variety of body systems, including the gastrointestinal tract and brain.

In autopsies of people with chronic fatigue syndrome, researchers also found enterovirus RNA and proteins in patients’ brains, including, in one case, in the brain stem region. The brain stem controls sleep cycles, autonomic function (the largely unconscious system driving bodily functions, such as digestion, blood pressure, and heart rate), and the flu-like symptoms we develop in response to inflammation and injury.

“If that area of the brain signaling becomes dysregulated [by viruses],” Proal said, “[that] can result in sets of symptoms that meet a diagnostic criteria for [chronic fatigue syndrome], or even for long Covid.”

2) Other pathogens lurking in the body reawaken

Other pathogens already lurking in the body prior to a coronavirus infection might also exacerbate symptoms. For example, viruses in the herpes family — such as Epstein-Barr (the cause of mono) or varicella zoster (the cause of chickenpox and shingles) — stay dormant in the body forever. Under normal conditions, the immune system can keep them in check.

“So, for example, 90 percent of people in the world already have herpes viruses,” said Proal. “But in those patients, the immune system keeps them in a place where they can’t replicate, where they can’t express proteins. They’re kind of controlled.”

But then Covid-19 comes along, and all of a sudden these other viruses get a chance to gain a foothold again. With the immune system tied up fighting Covid-19, the other viruses may reawaken. And they — not the coronavirus — drive symptoms.

3) The immune system turns on the body

Another key hypothesis: Long-Covid patients have developed an autoimmune disorder. The virus interrupts normal immune function, causing it to misfire, so that molecules that normally target foreign invaders — like viruses — turn on the body.

These “rogue antibodies,” known as autoantibodies, “attack either elements of the body’s immune defences or specific proteins in organs such as the heart,” according to Nature. The assault is thought to be distinct from cytokine storm, an acute immune system disorder that appeared as a potential threat early in the pandemic.

“Under that scenario, we talk about molecular mimicry,” Proal said. “Basically, the virus creates proteins that look like human proteins or tissue, and that kind of tricks the immune system.” Here, the the immune system tries to target the virus, which “if it has a similar size and shape to a human tissue or protein, it fires on the human tissue or protein as well,” she added.

4) The microbiome gets thrown out of whack

It’s also possible the coronavirus might deplete important microorganisms in the gut microbiome — the trillions of bacteria, viruses, and fungi that live in and on the body.

In one study, researchers tracked blood and stool samples from 100 patients hospitalized with SARS-CoV-2 infection, testing some up to 30 days after they cleared the virus. (They also collected samples from a control group for comparison.) And they found Covid-19 infection was linked to a “dysbiotic gut microbiome,” even after the virus cleared the respiratory tract; they also hypothesized that it might contribute to the persistent health problems some patients are experiencing.

“Under conditions of health, those communities are in a state of balance. It’s like a forest, like different organisms are doing different things, but it’s in a harmonious state,” Proal said. But Covid-19 could lead to an imbalance in the microbiome. “And a huge number of symptoms are tied to microbiome dysbiosis. Irritable bowel syndrome or even neuro-inflammatory symptoms can be driven by these ecosystems when they go out of balance, too.”

5) The body is injured

The virus might have cleared the body but left injuries in its wake — scars in the lungs or damage to the heart, for example — and these injuries might give rise to symptoms.

According to a recent preprint involving 201 patients, 70 percent had impairments in one or more organs four months after their initial Covid-19 symptoms set in. In other unpublished research, radiologists at the University of Southern California tracked hospitalized patients’ lung recovery using CT scans. They found one-third had scars caused by tissue death more than a month later. Other patients may have brain damage that causes neurological symptoms.

There’s also growing evidence of widespread cardiac injury, even in patients who aren’t hospitalized. In a JAMA Cardiology study, researchers performed cardiac MRIs on 100 patients in Germany who had recovered from Covid-19 within the past two to three months. An astounding 78 percent still had heart abnormalities.

For coronavirus patients who had to be admitted to intensive care units, there’s a related explanation: Long before the pandemic, the intensive care community coined a term for the persistent symptoms people frequently experience following stays in an ICU for any reason, from cancer to tuberculosis. These symptoms include muscle weakness, brain fog, sleep disturbances, and depression — the aftermath of a body lying around in a hospital bed for days on end and injuries or side effects from treatments patients received, including intubation.

The term “post-intensive care syndrome” was “created to raise awareness and education, because so many of our ICU survivors were going to their primary care doctor saying they were fatigued,” said Dale Needham, who has been treating Covid-19 patients in the ICU at Johns Hopkins. “They had trouble remembering, and they were weak. Their primary care doctor would do some lab tests and say, ‘Oh, there’s nothing wrong with you.’ The patient might walk away and feel like the doctor was saying, ‘It’s all in your head. You’re making it up.’”

The Covid-inspired medical revolution

So what might help alleviate the nagging symptoms of Covid long-haulers? One idea that’s been circulating is the Covid-19 vaccine: Some long-haulers are reporting their symptoms improving after they’ve gotten immunized. But others have reported feeling worse — and still others, no different. So researchers are racing to understand the effects of vaccination on long Covid, but it isn’t looking like a silver bullet just yet.

Proal had a simpler solution that could be implemented today: “It’s time for medicine to be rooted in just believing the patient.”

Even with growing awareness about long Covid, patients with the condition — and other chronic “medically unexplained” symptoms — are still too often minimized and dismissed by health professionals.

People “want disease to kill you, or they want you to return to miraculous good health,” said Jaime Seltzer, director of scientific and medical outreach at the chronic fatigue syndrome advocacy group ME Action. “When you stay sick, compassion can fade. And that is not just friends and family. That is your clinicians as well; they want somebody fixable.”

But long-haulers of any chronic condition can exist in a space between sickness and health for years, sometimes without a diagnosis. Their unexplainable symptoms can elicit outright skepticism in health professionals who are trained to consider patient feedback the “lowest form of evidence on [the evidence hierarchy], even under research on mice,” Proal said.

The situation can be even more challenging for patients who never had a positive PCR test confirming their Covid-19 diagnosis. Of the dozens of medical appointments one Covid-19 long-hauler, Hannah Davis, had for her ongoing symptoms — which include memory loss, muscle and joint pain, and headaches a year after her initial disease — one of the best experiences involved a doctor who simply said, “I don’t know.”

“The doctor [told me], ‘We are seeing hundreds of people like you with neurological symptoms. Unfortunately, we don’t know how to treat this yet. We don’t even understand what’s going on yet. But just know you’re not alone,’” she recounted. “And that’s the kind of conversation that needs to be happening. Because we can wait, but we can’t have the doctor’s anxiety being projected onto us as patients.”

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