vox--2020-07-29--The odd, growing list of Covid-19 symptoms, explained

More than six months into the coronavirus pandemic , the list of symptoms caused by the disease Covid-19 is still getting longer .
Beyond the most common symptoms of cough , fever , and shortness of breath , patients have reported other troubling maladies : vomiting , rashes , a loss of taste and smell , muscle aches , and even toe lesions dubbed “ Covid toes.
” With more than 16.5 million confirmed cases worldwide , researchers are getting a better handle on the early warning signs of infection and how it plays out throughout the body during the @ @ @ @ @ @ @ insights into symptoms are shedding light on what the virus does to the body , when patients are at highest risk of infecting others , and potential ways to treat it .
And with a larger pool of people recovered from the infection , long-term effects of the illness are also emerging , including symptoms that won ’ t go away .
“ Covid-19 can result in prolonged illness , even among young adults without underlying chronic medical conditions , ” according to a July 24 Centers for Disease Control and Prevention report @ @ @ @ @ @ @ in three symptomatic adults who were surveyed still weren ’ t fully recovered between two and three weeks after testing positive for Covid-19 .
“ It is such a unique infection in its ability to cause so much damage in so many different ways , in so many different organ systems , ” said Andrew Chan , a professor of immunology and infectious disease at the Harvard T.H .
Chan School of Public Health and co-founder of the COVID Symptom Study app .
“ It ’ s been very humbling for us as @ @ @ @ @ @ @ The growing of list of Covid-19 symptoms , short- and long-term , is yet another example of our evolving understanding of the disease , from how it spreads to how long immunity may last to what treatments may be effective .
There is likely much more still to learn about Covid-19 symptoms as scientists gather more data , but here is what they ’ ve uncovered in recent months about the signs of the disease , how clusters of symptoms can signal more severe complications , and the collateral damage throughout the body @ @ @ @ @ @ @ about Covid-19 symptoms A recent survey from the CDC identified several symptoms common across the infected .
“ Among 164 symptomatic COVID-19 patients , nearly all experienced fever , cough , or shortness of breath , ” according to a July 17 report from the agency .
“ However , a wide variety of other symptoms were also reported ; chills , myalgia [ muscle soreness ] , headache , fatigue , and the presence of at least one [ gastrointestinal ] symptom ( most commonly diarrhea ) were each reported by > @ @ @ @ @ @ @ with earlier surveys , like one from the World Health Organization back in February , which found conventional symptoms of a respiratory infection were common in Covid-19 patients in China .
The most common signs among more than 55,000 confirmed cases were : fever ( 87.9 percent of confirmed cases ) , dry cough ( 67.7 percent ) , fatigue ( 38.1 percent ) , sputum [ phlegm ] production ( 33.4 percent ) , shortness of breath ( 18.6 percent ) , sore throat ( 13.9 percent ) , and headache ( @ @ @ @ @ @ @ this from earlier in the pandemic had a harder time detecting milder symptoms .
Most of the reports were among patients that were hospitalized or had received medical treatment for Covid-19 , meaning they were already experiencing a severe course of the disease .
People with less alarming signs were often not detected .
To suss out some of the more subtle symptoms of Covid-19 , Harvard ’ s Chan and his team developed the COVID Symptom Study app , a mobile app that lets users self-report symptoms daily , whether or not @ @ @ @ @ @ @ test for Covid-19 .
The app currently has more than 4 million users in the US alone .
By tracking symptoms across large groups of people , Chan and his collaborators have been able to identify emerging Covid-19 hot spots and detect new signals of the virus .
“ The symptom that appears to be the strongest predictor of Covid continues to be a loss of taste or smell , and that ’ s been a thing that ’ s been continually shown in the data we ’ re getting in the app @ @ @ @ @ @ @ particular , the fact that that symptom is relatively uncommon in other viral syndromes , certainly uncommon in seasonal allergies , makes it useful.
” The CDC added a loss of taste and smell to its symptoms guidelines in April , and Chan published his findings in a May 11 paper in the journal Nature Medicine .
Since it ’ s a more unique symptom to Covid-19 than fever , Chan suggested that screening for taste and smell could serve as a stopgap way to detect infections , especially in places with testing @ @ @ @ @ @ @ imagine that tests that are able to pick up a loss of smell might be easier to deploy at a large scale , might be more cost-efficient , and could really address some of the shortcomings of our present efforts with respect to testing , ” Chan said .
Even more recently , the app has started to pick up signs that skin rashes — raised skin bumps , itchy and red skin , and inflammation on fingers and toes — could be a harbinger of Covid-19 for some .
In a recent @ @ @ @ @ @ @ not yet been peer-reviewed , researchers conducted a subsequent survey based on these hints .
They found that of 11,546 respondents , 17 percent of people with a confirmed Covid-19 infection reported that a rash was their first symptom .
Of the patients reporting rashes , 21 percent said that rashes were their only symptom .
“ Even though skin rashes may not be that common in Covid , the fact that they do arise , the fact that they may be a more specific sign , highlight how important it is to @ @ @ @ @ @ @ they are , ” Chan said .
Other preliminary studies , like one of 204 patients in China , found that more than half of Covid-19 patients experienced gastrointestinal problems like diarrhea , vomiting , and abdominal pain .
Some Covid-19 patients reported runny noses .
Others experienced feelings of discomfort and malaise .
In children , Covid-19 — even previously undetected cases — can spur an inflammatory condition similar to one known as Kawasaki disease .
Several elderly people infected with the virus exhibited neurological maladies like confusion and seizures .
And @ @ @ @ @ @ @ abnormal blood clotting , causing strokes in otherwise healthy people .
In short , there are a lot of different ways that Covid-19 can show up in a person .
But at the same time , an unknown number of people may be infected without showing any outward signs at all .
Studies have found the share of asymptomatic patients can comprise anywhere from 18 percent to 40 percent of infected people .
The precise fraction of people infected with Covid-19 who are completely asymptomatic is still being studied , but it ’ @ @ @ @ @ @ @ who can spread the virus without coughing or feeling feverish .
Even among patients who do show symptoms , some studies have found that they are most infectious just before they start feeling off , rather than when they suffer their worst fevers , rashes , or breathing problems .
That means it ’ s critical to identify infected people as early as possible and have them isolate from others in order to control the pandemic .
And while symptoms can serve as a diagnostic tool in a pinch , robust testing is @ @ @ @ @ @ @ contain the spread of Covid-19 .
Clusters of Covid-19 symptoms can predict more severe complications from the infection Many Covid-19 symptoms overlap with those of other illnesses , so the patterns of how they emerge together can be a more useful warning sign for the virus than any one symptom alone .
In another pre-print paper using data from the tracking app , researchers identified six distinct clusters of symptoms for Covid-19 .
These groupings were associated with varying degrees of severity of illness .
For instance , among patients experiencing one cluster @ @ @ @ @ @ @ smell , loss of appetite , cough , fever , hoarseness , sore throat , chest pain , fatigue , confusion , and muscle pain — 9.9 percent of them ended up needing supplemental oxygen or ventilation .
Meanwhile , patients who experienced the above symptoms , but in addition experienced shortness of breath , diarrhea , and abdominal pain , faced far more severe outcomes .
About half of the patients with this second symptom cluster were hospitalized , and 19.8 percent of them required breathing support .
So it ’ s @ @ @ @ @ @ @ together that are associated with how the disease progresses .
These clusters often emerge in the first five days of the illness , but people who need help breathing often arrive nearly two weeks after they first start showing signs .
That means symptom clusters could serve as an early alert , helping health providers anticipate the likelihood of a patient needing to be hospitalized and perhaps prompt earlier treatment .
Being able to identify Covid-19 symptoms matters for preventing spread When testing is slow or lacking , a cough and fever are @ @ @ @ @ @ @ diagnosed as a Covid-19 patient , with the associated protocols for isolation .
And while waiting for a test result , people often have to decide how to isolate from others and take precautions based on what they feel .
After exposure to the virus , it can take two to 14 days for a patient to experience symptoms , if they feel them at all .
During that time , these presymptomatic people can spread the virus to other people — especially in the couple of days before they start feeling sick @ @ @ @ @ @ @ in is also important because guidelines for distancing after an infection are often based on when they arise .
“ For most persons with COVID-19 illness , isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours , without the use of fever-reducing medications , and with improvement of other symptoms , ” according to new CDC guidance based on new information about how long the virus is active and transmissible ( emphasis in the original document ) .
And as the @ @ @ @ @ @ @ a specific group of warning signs can signal that a more severe course of the disease is in store in the coming days .
Some symptoms of Covid-19 stem from the immune system ’ s response Fever , rashes , and inflammation are often the signs of the immune system ’ s battle with an infection .
But sometimes , the immune system can overreact , causing conditions like cytokine storms where the body overproduces cytokines , signaling molecules that alert cells to an infection .
That can cause immune cells to attack @ @ @ @ @ @ @ failure of organs like the liver and kidneys and eventually , death .
Even among survivors , this can cause lasting damage .
Still , despite its complexity as a disease , researchers are learning that Covid-19 operates in ways that are distinct from many other infections .
Acute respiratory distress syndrome ( ARDS ) stemming from Covid-19 is a case in point .
ARDS is a condition in some of the most severe Covid-19 cases , causing the lungs to flood with fluid , cutting off oxygen supply to the blood .
@ @ @ @ @ @ @ treated with a ventilator , and are frequently left with severe organ damage .
Nuala Meyer , a critical care lung doctor at the University of Pennsylvania ’ s Perelman School of Medicine who studies ARDS , typically treats patients suffering with ARDS as the result of the flu .
But , she said “ the patients we were seeing [ with Covid-19 ] were quite different.
” With flu patients who have ARDS , doctors expect the very worst cases to be among those with asthma , or those who are immunocompromised @ @ @ @ @ @ @ were more likely to have heart disease , high blood pressure , diabetes , or obesity .
“ They generally did not have asthma , ” she said .
“ And some of the patients who were immunocompromised did do really poorly and others did surprisingly well.
” It ’ s been hard for doctors to predict which Covid-19 patients will fare worse , and develop severe complications like ARDS .
But recently , a study from Meyer and her colleagues added new evidence to what ’ s long been a theory : @ @ @ @ @ @ @ that ’ s causing the symptoms , but the patient ’ s own immune system .
In a study of 125 patients , Meyer and colleagues observed three different “ immunotypes ” or broad patterns of immune response , which may account for the range in severity of disease .
It ’ s currently not clear what leads someone to one immune response or another , but this work , and other work like it , can lead to the detection of biomarkers that indicate people most likely to experience severe disease .
@ @ @ @ @ @ @ outcomes , and spent the most time on a hospital ventilator , were more likely to have dysregulated immune response , Meyers said .
“ The fear is that either too persistent an [ immune ] activation or too robust an activation might contribute to the organ damage that we see , ” she said .
In Nature , researchers led by Akiko Iwasaki of Yale have noted that many of the most severe Covid-19 symptoms are correlated with an elevated cytokine response , which can lead to damaging inflammation .
The hope @ @ @ @ @ @ @ the immune response to the SARS-CoV-2 virus , doctors could diagnose patients who are most likely to have this severe reaction , and take steps to prevent the worst reaction from occurring .
“ That ’ s where we ’ d certainly like to go , ” Meyer said .
Researchers have already found that drugs that suppress the immune system like dexamethasone can save the lives of the most severely ill Covid-19 patients .
But since it tamps down the immune response , it can cause a milder infection to get worse @ @ @ @ @ @ @ pathogen .
That severely limits how useful it can be as a treatment , but it highlights the importance of tuning the immune system to thwart a disease without going any further .
Understanding the immune response to the virus is also critical to making a vaccine for Covid-19 , a tool that can ultimately end the pandemic .
As knowledge of Covid-19 and immunity improves , researchers expect to gain ground both in fighting the illness and preventing it altogether .
Covid-19 can have ripple effects throughout the body , but the @ @ @ @ @ @ @ a respiratory infection , it ’ s become increasingly apparent in recent months that its effects can have cascading consequences throughout the body .
Scientists are now piecing together the mechanisms behind these effects in hopes of stopping some of the worst outcomes and to get ahead of long-term problems .
Donald Landry , chair of the department of medicine at Columbia University , co-authored a recent study in the journal Nature Medicine looking at all the ways Covid-19 can impair the body beyond the lungs and airways .
The list is long @ @ @ @ @ @ @ acute kidney injury , gastrointestinal distress , liver damage , high blood sugar , neurologic illnesses , vision problems , and skin complications .
To understand why , it helps to examine how the virus itself works .
SARS-CoV-2 , the virus behind Covid-19 , starts an infection by docking one of its spike proteins with a receptor on a human cell known as ACE2 , which is involved in the regulation of blood pressure .
So the virus interfering with this mechanism can lead to problems stemming from constricted blood vessels .
@ @ @ @ @ @ @ in blood vessels that have the ACE2 receptor , can cause inflammation and blood clots .
But the virus may be doing something else still unknown that ’ s causing blood clots .
Landry noted that when Covid-19 patients were receiving treatments like ECMO and hemodialysis that involved circulating blood outside the body , the tubing transporting blood in and out of the body also clotted .
“ The clotting system itself seems to be revved , ” Landry said .
“ It ’ s not just inflamed blood vessels ; it ’ @ @ @ @ @ @ @ would seem.
” Those blood clots are dangerous because they can easily choke off tiny blood vessels and impede the blood supply to parts of the body — lungs , kidneys , the liver .
However , the damage to those organs can confusingly manifest in other parts of the body .
A failing kidney could mean less fluid is removed from the body , leading more fluid to accumulate in the lungs , worsening the respiratory symptoms of Covid-19 , according to Landry .
The effects of organ damage can also linger @ @ @ @ @ @ @ virus is eliminated .
If a blood clot blocks a vessel leading to the heart , for example , it can cause the death of a section of heart muscle , a condition known as a myocardial infarction .
“ You could be surviving the pulmonary part but you could be dying of the cardiac part , ” Landry said .
The ACE2 receptors are not just in blood vessels .
They can be found in cells in the lungs , so SARS-CoV-2 may be directly causing respiratory symptoms like coughing as it @ @ @ @ @ @ @ and kidney cells have this receptor and may be vulnerable to direct attack from the virus , potentially causing some of the observed cardiovascular symptoms .
So there are three potential sources of Covid-19 symptoms : the virus , the immune response to it , and the collateral damage from both .
However , sorting out what damage is caused by which mechanism remains a challenge .
“ That ’ s an open question as to what extent is it a primary cytotoxic effect from the virus infection , where it actually damages @ @ @ @ @ @ @ versus whether it ’ s damaging blood vessels , ” Landry said .
“ That whole area needs to be investigated.
” By understanding the mechanisms of Covid-19 , doctors can better anticipate the myriad ways it can present and come up with ways to counter its worst effects .
But it will take yet more research to build this foundation .
The symptoms of Covid-19 may stick around for a long time We ’ re now far enough into the pandemic that millions of people have recovered from Covid-19 .
While many @ @ @ @ @ @ @ finding that the illness has lasting effects on their health .
“ For many people , the infection is not a self-limited condition , ” Chan said .
“ Sometimes they ’ re left with longer-term symptoms that could be quite impairing.
” Already , recovered patients have reported ongoing coughing , trouble concentrating , and muscle weakness .
Doctors have also found lesions on the hearts , lungs , and brains of Covid-19 patients that can take a long time to heal and may be permanent in some cases .
“ Patients @ @ @ @ @ @ @ with Covid-19 , are beginning to present now with syndromes of pulmonary fibrosis , ” said Landry .
“ And this is really a grave lesion that can progress to end-stage , requiring lung transplantation.
” Meanwhile , patients with brain damage can suffer lasting speech and mobility issues .
Covid-19 survivors with heart damage can have persistent arrhythmias that can make it hard for them to conduct basic tasks .
Diminished functions of organs like kidneys could progress and contribute to future health problems .
“ There may be many more patients @ @ @ @ @ @ @ result of the severe damage they suffered to their kidney during the acute Covid-19 [ pandemic ] , ” Landry said .
And it ’ s not just people who fell severely ill who can suffer residual impacts .
Even people who had a less severe course of the disease have reported long-lasting symptoms .
Taken together , the early findings about the long-term impacts of Covid-19 show that the world will likely be seeing signs of the illness for years to come — even if the virus were to vanish tomorrow .
@ @ @ @ @ @ @ more symptoms and manifestations of the disease may yet emerge .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
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More than six months into the coronavirus pandemic, the list of symptoms caused by the disease Covid-19 is still getting longer.
Beyond the most common symptoms of cough, fever, and shortness of breath, patients have reported other troubling maladies: vomiting, rashes, a loss of taste and smell, muscle aches, and even toe lesions dubbed “Covid toes.”
With more than 16.5 million confirmed cases worldwide, researchers are getting a better handle on the early warning signs of infection and how it plays out throughout the body during the course of the disease. These new insights into symptoms are shedding light on what the virus does to the body, when patients are at highest risk of infecting others, and potential ways to treat it.
And with a larger pool of people recovered from the infection, long-term effects of the illness are also emerging, including symptoms that won’t go away. “Covid-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions,” according to a July 24 Centers for Disease Control and Prevention report. The same report found that one in three symptomatic adults who were surveyed still weren’t fully recovered between two and three weeks after testing positive for Covid-19.
“It is such a unique infection in its ability to cause so much damage in so many different ways, in so many different organ systems,” said Andrew Chan, a professor of immunology and infectious disease at the Harvard T.H. Chan School of Public Health and co-founder of the COVID Symptom Study app. “It’s been very humbling for us as physicians and as a scientific community.”
The growing of list of Covid-19 symptoms, short- and long-term, is yet another example of our evolving understanding of the disease, from how it spreads to how long immunity may last to what treatments may be effective. There is likely much more still to learn about Covid-19 symptoms as scientists gather more data, but here is what they’ve uncovered in recent months about the signs of the disease, how clusters of symptoms can signal more severe complications, and the collateral damage throughout the body.
What the most recent evidence says about Covid-19 symptoms
A recent survey from the CDC identified several symptoms common across the infected. “Among 164 symptomatic COVID-19 patients, nearly all experienced fever, cough, or shortness of breath,” according to a July 17 report from the agency. “However, a wide variety of other symptoms were also reported; chills, myalgia [muscle soreness], headache, fatigue, and the presence of at least one [gastrointestinal] symptom (most commonly diarrhea) were each reported by >50% of patients.”
This aligns with earlier surveys, like one from the World Health Organization back in February, which found conventional symptoms of a respiratory infection were common in Covid-19 patients in China. The most common signs among more than 55,000 confirmed cases were: fever (87.9 percent of confirmed cases), dry cough (67.7 percent), fatigue (38.1 percent), sputum [phlegm] production (33.4 percent), shortness of breath (18.6 percent), sore throat (13.9 percent), and headache (13.6 percent).
But surveys like this from earlier in the pandemic had a harder time detecting milder symptoms. Most of the reports were among patients who were hospitalized or had received medical treatment for Covid-19, meaning they were already experiencing a severe course of the disease. People with less alarming signs were often not detected.
To suss out some of the more subtle symptoms of Covid-19, Harvard’s Chan and his team developed the COVID Symptom Study app, a mobile app that lets users self-report symptoms daily, whether or not they feel sick or have had a test for Covid-19.
The app has more than 4 million users in the US alone. By tracking symptoms across large groups of people, Chan and his collaborators have been able to identify emerging Covid-19 hot spots and detect new signals of the virus.
“The symptom that appears to be the strongest predictor of Covid continues to be a loss of taste or smell, and that’s been a thing that’s been continually shown in the data we’re getting in the app,” said Chan. “In particular, the fact that that symptom is relatively uncommon in other viral syndromes, certainly uncommon in seasonal allergies, makes it useful.”
The CDC added a loss of taste and smell to its symptoms guidelines in April, and Chan published his findings in a May 11 paper in the journal Nature Medicine.
Since it’s a more unique symptom to Covid-19 than fever, Chan suggested that screening for taste and smell could serve as a stopgap way to detect infections, especially in places with testing shortages and backlogs. “You can imagine that tests that are able to pick up a loss of smell might be easier to deploy at a large scale, might be more cost-efficient, and could really address some of the shortcomings of our present efforts with respect to testing,” Chan said.
Even more recently, the app has started to pick up signs that skin rashes — raised skin bumps, itchy and red skin, and inflammation on fingers and toes — could be a harbinger of Covid-19 for some. In a recent preprint paper, a study that has not yet been peer-reviewed, researchers conducted a subsequent survey based on these hints. They found that of 11,546 respondents, 17 percent of people with a confirmed Covid-19 infection reported that a rash was their first symptom. Of the patients reporting rashes, 21 percent said that rashes were their only symptom.
“Even though skin rashes may not be that common in Covid, the fact that they do arise, the fact that they may be a more specific sign, highlight how important it is to really assess their prevalence and how predictive they are,” Chan said.
Other preliminary studies, like one of 204 patients in China, found that more than half of Covid-19 patients experienced gastrointestinal problems like diarrhea, vomiting, and abdominal pain. Some Covid-19 patients reported runny noses. Others experienced feelings of discomfort and malaise. In children, Covid-19 — even previously undetected cases — can spur an inflammatory condition similar to one known as Kawasaki disease. Several older people infected with the virus exhibited neurological maladies like confusion and seizures. Patients of all ages have also experienced abnormal blood clotting, causing strokes in otherwise healthy people.
Related How people without symptoms can still spread the coronavirus
In short, there are a lot of different ways that Covid-19 can show up in a person. But at the same time, an unknown number of people may be infected without showing any outward signs. Studies have found the share of asymptomatic patients can comprise anywhere from 18 percent to 40 percent of infected people.
The precise fraction of people infected with Covid-19 who are completely asymptomatic is still being studied, but it’s clear that there are infected people who can spread the virus without coughing or feeling feverish. Even among patients who do show symptoms, some studies have found that they are most infectious just before they start feeling off, rather than when they suffer their worst fevers, rashes, or breathing problems.
That means it’s critical to identify infected people as early as possible and have them isolate from others in order to control the pandemic. And while symptoms can serve as a diagnostic tool in a pinch, robust testing is still needed to identify hidden infections to contain the spread of Covid-19.
Clusters of Covid-19 symptoms can predict more severe complications from the infection
Many Covid-19 symptoms overlap with those of other illnesses, so the patterns of how they emerge together can be a more useful warning sign for the virus than any one symptom alone. In another preprint paper using data from the tracking app, researchers identified six distinct clusters of symptoms for Covid-19.
These groupings were associated with varying degrees of severity of illness. For instance, among patients experiencing one cluster of symptoms — headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, and muscle pain — 9.9 percent of them ended up needing supplemental oxygen or ventilation.
Meanwhile, patients who experienced the above symptoms, but in addition experienced shortness of breath, diarrhea, and abdominal pain, faced far more severe outcomes. About half of the patients with this second symptom cluster were hospitalized, and 19.8 percent of them required breathing support.
So it’s not just one symptom but several together that are associated with how the disease progresses. These clusters often emerge in the first five days of the illness, but people who need help breathing often arrive nearly two weeks after they first start showing signs. That means symptom clusters could serve as an early alert, helping health providers anticipate the likelihood of a patient needing to be hospitalized and perhaps prompt earlier treatment.
Being able to identify Covid-19 symptoms matters for preventing spread
When testing is slow or lacking, a cough and fever are often enough for a person to get diagnosed as a Covid-19 patient, with the associated protocols for isolation. And while waiting for a test result, people often have to decide how to isolate from others and take precautions based on what they feel.
After exposure to the virus, it can take two to 14 days for a patient to experience symptoms, if they feel them at all. During that time, these presymptomatic people can spread the virus to other people — especially in the couple of days before they start feeling sick.
Figuring out when key symptoms set in is also important because guidelines for distancing after an infection are often based on when they arise. “For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms,” according to new CDC guidance based on new information about how long the virus is active and transmissible (emphasis in the original document).
And as the recent findings about symptom clusters show, a specific group of warning signs can signal that a more severe course of the disease is in store in the coming days.
Some symptoms of Covid-19 stem from the immune system’s response
Fever, rashes, and inflammation are often the signs of the immune system’s battle with an infection. But sometimes, the immune system can overreact, causing conditions like cytokine storms where the body overproduces cytokines, signaling molecules that alert cells to an infection. That can cause immune cells to attack otherwise healthy cells, leading to the failure of organs like the liver and kidneys and, eventually, death. Even among survivors, this can cause lasting damage.
Still, despite its complexity as a disease, researchers are learning that Covid-19 operates in ways that are distinct from many other infections. Acute respiratory distress syndrome (ARDS) stemming from Covid-19 is a case in point.
ARDS is a condition in some of the most severe Covid-19 cases, causing the lungs to flood with fluid, cutting off oxygen supply to the blood. Patients with ARDS often need to be treated with a ventilator and are frequently left with severe organ damage.
Nuala Meyer, a critical care lung doctor at the University of Pennsylvania’s Perelman School of Medicine who studies ARDS, typically treats patients suffering with ARDS as the result of the flu. But, she said, “the patients we were seeing [with Covid-19] were quite different.”
With flu patients who have ARDS, doctors expect the very worst cases to be among those with asthma, or those who are immunocompromised. Instead, the worst-faring Covid-19 cases were more likely to have heart disease, high blood pressure, diabetes, or obesity. “They generally did not have asthma,” Meyer said. “And some of the patients who were immunocompromised did do really poorly and others did surprisingly well.”
It’s been hard for doctors to predict which Covid-19 patients will fare worse, and develop severe complications like ARDS. But recently, a study from Meyer and her colleagues added new evidence to what’s long been a theory: that it’s not the virus that’s causing the symptoms, but the patient’s immune system.
In a study of 125 patients, Meyer and colleagues observed three different “immunotypes” or broad patterns of immune response, which may account for the range in severity of disease. It’s currently not clear what leads someone to one immune response or another, but this work, and other work like it, can lead to the detection of biomarkers that indicate people most likely to experience severe disease. Those who had some of the worst outcomes, and spent the most time on a hospital ventilator, were more likely to have dysregulated immune response, Meyers said.
“The fear is that either too persistent an [immune] activation or too robust an activation might contribute to the organ damage that we see,” she said. In Nature, researchers led by Akiko Iwasaki of Yale have noted that many of the most severe Covid-19 symptoms are correlated with an elevated cytokine response, which can lead to damaging inflammation.
The hope is, with a better understanding of the immune response to the SARS-CoV-2 virus, doctors could diagnose patients who are most likely to have this severe reaction, and take steps to prevent the worst reaction from occurring. “That’s where we’d certainly like to go,” Meyer said.
Researchers have already found that drugs that suppress the immune system like dexamethasone can save the lives of the most severely ill Covid-19 patients. But since it tamps down the immune response, it can cause a milder infection to get worse or leave a patient susceptible to another pathogen. That severely limits how useful it can be as a treatment, but it highlights the importance of tuning the immune system to thwart a disease without going any further.
Understanding the immune response to the virus is also critical to making a vaccine for Covid-19, a tool that can ultimately end the pandemic. As knowledge of Covid-19 and immunity improves, researchers expect to gain ground both in fighting the illness and preventing it altogether.
Covid-19 can have ripple effects throughout the body, but the process is still unclear
While Covid-19 is a respiratory infection, it’s become increasingly apparent in recent months that its effects can have cascading consequences throughout the body. Scientists are now piecing together the mechanisms behind these effects in hopes of stopping some of the worst outcomes and to get ahead of long-term problems.
Donald Landry, chair of the department of medicine at Columbia University, co-authored a recent study in the journal Nature Medicine looking at all the ways Covid-19 can impair the body beyond the lungs and airways. The list is long: blood clots, irregular heartbeat, acute kidney injury, gastrointestinal distress, liver damage, high blood sugar, neurologic illnesses, vision problems, and skin complications.
To understand why, it helps to examine how the virus itself works. SARS-CoV-2, the virus behind Covid-19, starts an infection by docking one of its spike proteins with a receptor on a human cell known as ACE2, which is involved in the regulation of blood pressure. So the virus interfering with this mechanism can lead to problems stemming from constricted blood vessels. That interference, plus direct viral damage in blood vessels that have the ACE2 receptor, can cause inflammation and blood clots.
But the virus may be doing something else still unknown that’s causing blood clots. Landry noted that when Covid-19 patients were receiving treatments like ECMO and hemodialysis that involved circulating blood outside the body, the tubing transporting blood in and out of the body also clotted.
“The clotting system itself seems to be revved,” Landry said. “It’s not just inflamed blood vessels; it’s a hyper-coagulable state, so it would seem.”
Those blood clots are dangerous because they can easily choke off tiny blood vessels and impede the blood supply to parts of the body — lungs, kidneys, liver. However, the damage to those organs can confusingly manifest in other parts of the body. A failing kidney could mean less fluid is removed from the body, leading more fluid to accumulate in the lungs, worsening the respiratory symptoms of Covid-19, according to Landry.
The effects of organ damage can also linger and become permanent, even after the virus is eliminated. If a blood clot blocks a vessel leading to the heart, for example, it can cause the death of a section of heart muscle, a condition known as a myocardial infarction. “You could be surviving the pulmonary part but you could be dying of the cardiac part,” Landry said.
The ACE2 receptors are not just in blood vessels. They can be found in cells in the lungs, so SARS-CoV-2 may be directly causing respiratory symptoms like coughing as it damages those cells. Similarly, heart and kidney cells have this receptor and may be vulnerable to direct attack from the virus, potentially causing some of the observed cardiovascular symptoms.
So there are three potential sources of Covid-19 symptoms: the virus, the immune response to it, and the collateral damage from both. However, sorting out what damage is caused by which mechanism remains a challenge.
“That’s an open question as to what extent is it a primary cytotoxic effect from the virus infection, where it actually damages the cells it’s infecting, versus whether it’s damaging blood vessels,” Landry said. “That whole area needs to be investigated.”
By understanding the mechanisms of Covid-19, doctors can better anticipate the myriad ways it can present and come up with ways to counter its worst effects. But it will take yet more research to build this foundation.
The symptoms of Covid-19 may stick around for a long time
We’re now far enough into the pandemic that millions of people have recovered from Covid-19. While many are no longer contagious, some are finding that the illness has lasting effects on their health.
“For many people, the infection is not a self-limited condition,” Chan said. “Sometimes they’re left with longer-term symptoms that could be quite impairing.”
Already, recovered patients have reported ongoing coughing, trouble concentrating, and muscle weakness. Doctors have also found lesions on the hearts, lungs, and brains of Covid-19 patients that can take a long time to heal and may be permanent in some cases.
“Patients who have had terrible pneumonias or ARDS with Covid-19, are beginning to present now with syndromes of pulmonary fibrosis,” said Landry. “And this is really a grave lesion that can progress to end stage, requiring lung transplantation.”
Meanwhile, patients with brain damage can suffer lasting speech and mobility issues. Covid-19 survivors with heart damage can have persistent arrhythmias that can make it hard for them to conduct basic tasks. Diminished functions of organs like kidneys could progress and contribute to future health problems.
“There may be many more patients on hemodialysis in the future as a result of the severe damage they suffered to their kidney during the acute Covid-19 [pandemic],” Landry said.
And it’s not just people who fell severely ill who can suffer residual impacts. Even people who had a less severe course of the disease have reported long-lasting symptoms.
Taken together, the early findings about the long-term impacts of Covid-19 show that the world will likely be seeing signs of the illness for years to come — even if the virus were to vanish tomorrow. And in the coming months, even more symptoms and manifestations of the disease may yet emerge.


vox--2020-07-29--Surgical gowns cost my hospital 40 cents before the pandemic. Now they’re $9.

Over 16.5 million people around the world have been infected by Covid-19 , and the numbers continue to rise steadily .
The pandemic has severely disrupted almost every aspect of the global economy , including the global supply chain .
Across the world , factories have shut down or slowed production ; countries have restricted exports and imports ; and transportation has slowed or halted .
While this turmoil has affected many industries , America ’ s health care system has been hit especially hard .
Over the past two decades , US health care has come to rely heavily @ @ @ @ @ @ @ , for thousands of essential products , from surgical gowns to syringes .
In fact , as of 2019 , the US was the largest importer of medical goods — including of personal protective products — in the world .
Over the past few months as the pandemic raged , most US hospitals and health systems have responded by turning to domestic suppliers .
They are more reliable given the difficulties with transportation and trade , which have become worse since the pandemic began .
This trend is likely to continue , as @ @ @ @ @ @ @ ensure that they have a steady supply of essential products .
But this new domestic strategy has a particular disadvantage : In general , it is much more expensive .
And this puts hospitals , and potentially , their patients in greater financial jeopardy .
Higher domestic prices are likely due to a combination of the increased costs of manufacturing in the US , as well as the booming demand that has outpaced supply .
For example , in December , Johns Hopkins Medicine , where I oversee the supply chain , was @ @ @ @ @ @ @ our supplier in China .
We are now paying $ 9 per gown , from a domestic supplier .
That ’ s more than 20 times the former price — all at a time when we need more gowns than ever .
This change has the potential to significantly increase health care costs , and will only add to the existing strain on health care providers , health insurers , and consumers .
Right now , increased supply costs may not seem like the most important health care issue we face .
And @ @ @ @ @ @ @ task of saving lives obviously takes precedence over all other concerns .
But to save lives , we need personal protective equipment , we need tubing , we need gowns .
And we also need to be able to ensure the long-term financial sustainability of our institutions .
Without a reliable , affordable supply of a range of products , we can ’ t properly care for our patients , both those with Covid-19 and those with other health problems .
How the medical supply crisis got so bad The current supply problems @ @ @ @ @ @ @ coronavirus epidemic in Wuhan and the realization that it would likely spread globally , hospitals around the world began to stock up on supplies , which decreased their availability .
Beyond the overall turmoil brought on by the pandemic , China took additional steps to protect itself that further obstructed the supply chain .
In February , to ensure that the country had adequate domestic supply , the Chinese government took over the production and distribution of medical products .
China was not the only country to do this , but because it @ @ @ @ @ @ @ many health care products — personal protective equipment ( PPE ) such as N95 masks , medical devices , antibiotics and pharmaceutical ingredients , to name a few — the decision had major consequences .
In 2019 alone , China supplied a quarter of the entire globe ’ s face masks .
According to the Congressional Research Service , which earlier this year published a report on US imports of medical supplies , China exported in 2019 nearly $ 21 billion in pharmaceuticals , medical equipment , and health care products to the @ @ @ @ @ @ @ for 2020 , but health care imports from China will almost certainly drop significantly .
For some products , US reliance on China was particularly high .
Last year , the US imported $ 1.9 billion in PPE from China , about 30 percent of our total PPE imports .
China ’ s response is understandable ; it was dealing with a significant disease outbreak .
But in the US , this move kicked off shortages of PPE , as well as some medicines , and other important health care products — shortages @ @ @ @ @ @ @ recovered .
Can we fix the supply problem before the pandemic ends ?
China seems to have its outbreak relatively under control , and it has now somewhat eased limits on exports of medical supplies .
This is good news , but the steps so far will not meet the overall increased demand .
The pandemic will continue to wreak havoc with logistics , creating bottlenecks that have slowed the movement of supplies .
Pandemic restrictions , in particular physical distancing , slow down almost every part of the process , especially production @ @ @ @ @ @ @ us that they are starting to see shortages in the raw materials they need for production , such as the material typically used to make isolation gowns .
So it ’ s likely that health care providers will continue to rely more on domestic suppliers .
There are some benefits to this turn to US supplies .
The route from factory to bedside is more stable , and providers are helping to support US workers , and the US economy .
But at the same time , the higher costs are putting pressure @ @ @ @ @ @ @ pandemic , most providers were striving to cut budgets .
Those pressures will only grow : the pandemic has increased costs at many hospitals ( see : the huge increase in the costs of medical gowns ) , while also reducing revenue , due to the enormous number of appointments and elective procedures ( which usually generate a substantial amount of health care systems ’ income ) that have been canceled and postponed .
So what can we do ?
I don ’ t have all the answers , and to be honest @ @ @ @ @ @ @ does .
The first step is to raise awareness of the problem .
On the ground , a potential solution is to return to reusable supplies .
Over the past two decades , most hospitals replaced many reusable products with disposables .
Johns Hopkins , and I suspect many other systems , will reconsider that choice .
And we can do more to conserve supplies , using them carefully and only when necessary .
We also need to diversify our supply chains , connecting with manufacturers in India , Central America , and @ @ @ @ @ @ @ self-manufacturing ; over the past few months , for instance , volunteers at Johns Hopkins have assembled tens of thousands of face shields .
Of course , this sort of free labor is not the solution , but local supply handling could help ease the burden somewhat .
Federal and state governments can help by ensuring that domestic product manufacturers aren ’ t unfairly raising prices , as has apparently occurred in some places .
They could also provide financial and logistical support to health care providers so they can better manage higher @ @ @ @ @ @ @ to evolve , the health care system and its partners will need to develop creative solutions to help ensure that hospitals can continue to afford to keep everyone safe .
Lisa Ishii , a head and neck surgeon , is the senior vice president of operations for Johns Hopkins Health System .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital @ @ @ @ @ @ @ to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

More than 16.5 million people around the world have been infected by the coronavirus, and the numbers continue to rise steadily. The pandemic has severely disrupted almost every aspect of the global economy, including the global supply chain. Across the world, factories have shut down or slowed production; countries have restricted exports and imports; and transportation has slowed or halted.
While this turmoil has affected many industries, America’s health care system has been hit especially hard. Over the past two decades, US health care has come to rely heavily on international suppliers, especially in China, for thousands of essential products, from surgical gowns to syringes. In fact, as of 2019, the US was the largest importer of medical goods — including of personal protective products — in the world.
Over the past few months as the pandemic raged, most US hospitals and health systems have responded by turning to domestic suppliers. They are more reliable given the difficulties with transportation and trade, which have become worse since the pandemic began.
This trend is likely to continue, as hospitals and health care systems try to ensure that they have a steady supply of essential products.
But this new domestic strategy has a particular disadvantage: In general, it is much more expensive. And this puts hospitals — and, potentially, their patients — in greater financial jeopardy.
Higher domestic prices are likely due to a combination of the increased costs of manufacturing in the US, as well as the booming demand that has outpaced supply. For example, in December, Johns Hopkins Medicine, where I oversee the supply chain, was paying 40 cents for a gown from our supplier in China. We are now paying $9 per gown from a domestic supplier. That’s more than 20 times the former price — all at a time when we need more gowns than ever. This change has the potential to significantly increase health care costs and will only add to the existing strain on health care providers, health insurers, and consumers.
Right now, increased supply costs may not seem like the most important health care issue we face. And it’s not. The immediate task of saving lives obviously takes precedence over all other concerns.
But to save lives, we need personal protective equipment, we need tubing, we need gowns. And we also need to be able to ensure the long-term financial sustainability of our institutions. Without a reliable, affordable supply of a range of products, we can’t properly care for our patients, both those with Covid-19 and those with other health problems.
How the medical supply crisis got so bad
The current supply problems began in January. With the initial coronavirus epidemic in Wuhan and the realization that it would likely spread globally, hospitals around the world began to stock up on supplies, which decreased their availability. Beyond the overall turmoil brought on by the pandemic, China took additional steps to protect itself that further obstructed the supply chain.
In February, to ensure that the country had adequate domestic supply, the Chinese government took over the production and distribution of medical products. China was not the only country to do this, but because it is a leading global supplier of so many health care products — personal protective equipment (PPE) such as N95 masks, medical devices, antibiotics, and pharmaceutical ingredients, to name a few — the decision had major consequences. In 2019 alone, China supplied a quarter of the entire globe’s face masks.
According to the Congressional Research Service, which earlier this year published a report on US imports of medical supplies, China exported in 2019 nearly $21 billion in pharmaceuticals, medical equipment, and health care products to the US. There are no figures yet for 2020, but health care imports from China will almost certainly drop significantly.
For some products, US reliance on China was particularly high. Last year, the US imported $1.9 billion in PPE from China, about 30 percent of our total PPE imports.
China’s response is understandable; it was dealing with a significant disease outbreak. But in the US, this move kicked off shortages of PPE, as well as some medicines, and other important health care products — shortages from which we haven’t yet recovered.
Can we fix the supply problem before the pandemic ends?
China seems to have its outbreak relatively under control, and it has now somewhat eased limits on exports of medical supplies. This is good news, but the steps so far will not meet the overall increased demand.
The pandemic will continue to wreak havoc with logistics, creating bottlenecks that have slowed the movement of supplies. Pandemic restrictions, in particular physical distancing, slow down almost every part of the process, especially production. And some of our suppliers tell us that they are starting to see shortages in the raw materials they need for production, such as the material typically used to make isolation gowns. So it’s likely that health care providers will continue to rely more on domestic suppliers.
There are some benefits to this turn to US supplies. The route from factory to bedside is more stable, and providers are helping to support US workers and the US economy.
But at the same time, the higher costs are putting pressure on health care; even before the pandemic, most providers were striving to cut budgets. Those pressures will only grow: The pandemic has increased costs at many hospitals (see: the huge increase in the costs of medical gowns), while also reducing revenue due to the enormous number of appointments and elective procedures (which usually generate a substantial amount of a health care systems’ income) that have been canceled and postponed.
So what can we do? I don’t have all the answers, and to be honest, I don’t think anyone does. The first step is to raise awareness of the problem.
On the ground, a potential solution is to return to reusable supplies. Over the past two decades, most hospitals replaced many reusable products with disposables. Johns Hopkins, and I suspect many other systems, will reconsider that choice. And we can do more to conserve supplies, using them carefully and only when necessary.
We also need to diversify our supply chains, connecting with manufacturers in India, Central America, and elsewhere. We can also focus on self-manufacturing; over the past few months, for instance, volunteers at Johns Hopkins have assembled tens of thousands of face shields. Of course, this sort of free labor is not the solution, but local supply handling could help ease the burden somewhat.
Federal and state governments can help by ensuring that domestic product manufacturers aren’t unfairly raising prices, as has apparently occurred in some places. They could also provide financial and logistical support to health care providers so they can better manage higher supply costs.
As this situation continues to evolve, the health care system and its partners will need to develop creative solutions to help ensure that hospitals can continue to afford to keep everyone safe.
Lisa Ishii, a head and neck surgeon, is the senior vice president of operations for Johns Hopkins Health System.


vox--2020-07-29--Student activists want change — and they’re starting in the classroom

Throughout her three years at Westminster High School in Southern California , Liana Le recalled reading only a handful of books that featured nonwhite perspectives .
But even when those books featured people of color — in the case of To Kill a Mockingbird , for example — the 16-year-old realized that the book was often written by a white author who failed to portray Black characters with depth , agency , and thoughtfulness .
“ It made me realize how representation in literature is so important , ” the rising senior told me .
“ Talking about the Black @ @ @ @ @ @ @ a removed point of view and reading it from a white author isn ’ t enough .
We must include and hear other voices.
” In early June , Le discovered Diversify Our Narrative , a campaign spearheaded by California college students with the aim of introducing more diverse , anti-racist texts in America ’ s public school system .
She is one of roughly 1,700 students across 200 school districts in the US to have signed up as a community organizer ; she was then given tools and resources , like email @ @ @ @ @ @ @ start a local petition targeting her community and school board .
Currently , Le and 17 others are working to present their proposal at Huntington Beach ’ s school board meeting on August 11 .
“ We ’ re figuring out what we want to implement in the school curriculum since it ’ s such a new initiative , ” Le said , “ but we ’ re trying to start small and slowly inch our way up , while also trying to fundraise for new books.
” The Diversify Our Narrative campaign @ @ @ @ @ @ @ and fiction titles Le hopes to draw from , featuring books like The Bluest Eye by Toni Morrison , There There by Tommy Orange , and Between the World and Me by Ta-Nehisi Coates .
Le and her peers are not alone in their efforts .
As the country examines the systemic racism embedded in our institutions amid months of nationwide Black Lives Matter protests , high school students , alumni , and teachers across the country are petitioning their local governments and school boards to implement curriculum changes .
This includes diversifying @ @ @ @ @ @ @ color , introducing ethnic studies programs , and expanding the scope of existing history classes .
Many advocates have also drawn from their own classroom experiences to highlight other pressing issues beyond curriculum : the need for increased teacher diversity , initiatives to reduce the racial achievement gap in schools , and more lenient disciplinary policies when addressing students ’ problematic behaviors .
In school districts from California to Texas to New Jersey , board leaders and administrators have been urged to acknowledge the systemic racism that persists in education .
And while @ @ @ @ @ @ @ to equity and inclusion , students realize that a curriculum overhaul could take time and , in some cases , receive political pushback .
Major curriculum change is tricky .
Young activists want small changes while aiming for a larger overhaul .
Since the United States doesn ’ t have a national education system , states are largely responsible for setting certain educational goals and curricula for subjects like American history , math , and English .
To make things easier , a majority of states since 2010 have adopted the Common Core @ @ @ @ @ @ @ national nonprofit groups to better measure students ’ academic performance .
Yet the Common Core appears to rely on classic , decades-old works — published primarily by white authors — to teach and assess students grades 6 to 12 , according to the sample performance tests posted on its site .
At the high school level , some students also take a variety of Advanced Placement courses by the College Board , a not-for-profit organization that dominates the curriculum and testing market for most college-bound students .
Since these classes tend to be @ @ @ @ @ @ @ the end-of-year test , however , there ’ s little room for teachers to explore supplementary topics or readings .
That ’ s a problem , critics say , especially when most of its history courses are heavily Eurocentric .
According to the Atlantic , the AP art history course , which was revised in 2016 , still features about 65 percent of art within the Western tradition , with 35 percent hailing from “ other artistic traditions.
” When the College Board sought to revise its world history curriculum in 2018 , @ @ @ @ @ @ @ , and the American Historical Association , who felt the proposed plan still placed too much emphasis on Western culture .
AP world history was developed in part to counter the Western focus of the AP ’ s other courses ( US and European history ) , whose timelines began in 1450 CE and heavily emphasized the development of the European empires and colonization .
The organization eventually addressed critics ’ misgivings by changing the starting year of the world history class to 1200 CE and creating a second AP course that covers @ @ @ @ @ @ @ The AP art history course , which was revised in 2016 , still features about 65 percent of art within the Western tradition , with 35 percent hailing from “ other artistic traditions ” The decision , however , didn ’ t necessarily resolve the debate as to what constitutes “ world history , ” or whether expanding the historical scope of the course would help students better understand human history .
As David M. Perry , a former professor of history , wrote in Pacific Standard , the AP ’ s world @ @ @ @ @ @ @ dates or coverage over time .
Rather , the class should be better organized , allowing teachers to select case studies and “ choose a balanced array of diverse places and cultures on which to concentrate.
” Meanwhile , white authors and Eurocentric perspectives are still heavily overrepresented in most English and history courses across the country , too — regardless of student demographics .
A 2018 analysis of New York City ’ s public school system of three popular elementary school resources found that authors of both fiction novels and curriculum materials @ @ @ @ @ @ @ system ’ s diverse student population ( in the 2018- ’ 19 academic year , NYC ’ s school system was 26 percent Black , 41 percent Hispanic , 16 percent Asian , and 15 percent white ) .
NYU Steinhardt researchers in the report noted that studies show students are “ more engaged in literature and history lessons , and more likely to have a positive perception of their ability to succeed in math and science ” when they feel connected to learning content where their identities are reflected .
Relatedly , @ @ @ @ @ @ @ are pushing to improve , or even initiate , curriculum .
California , Vermont , and Oregon are among a handful of states that have set out to develop ethnic studies curriculums .
In most states , however , these courses aren ’ t required — or even offered — in schools .
But even in school systems with more students of color , many notice how ethnic studies courses are usually an afterthought or become the center of political controversy .
In California ’ s proposed K-12 ethnic studies curriculum , materials @ @ @ @ @ @ @ Black Americans , Latinos , and Native Americans , according to the New York Times .
Yet educators making these decisions have to grapple with questions of inclusion ( Jews , Armenians , and Koreans felt they were left out ) and whether the majority of teachers ( who are white ) are capable of teaching a subject they might be unfamiliar with .
Overhauling an entire state ’ s school system , let alone the centuries-old institution that is American education , is overwhelming , to say the least .
For many @ @ @ @ @ @ @ .
“ Altering curriculum that ’ s already set in place , like AP courses , is going to be difficult , ” Le told me .
“ We think it ’ ll be easier to implement changes at the freshman or sophomore levels [ of high school ] , where there ’ s only honors or general-level classes , and we can fundraise for novels.
” Shajei Haider , a 2012 graduate of South Brunswick High School in New Jersey , said that he and a coalition of alumni are urging the @ @ @ @ @ @ @ American literature course , as well as introduce culturally relevant Black history into its traditional courses .
In traditional English courses , students have said they ’ ve been taught books with outdated views on race , where teachers don ’ t provide proper context or even directly address modern-day racism .
Haider believes short-term changes are possible while pushing for longer-term solutions .
For example , “ we ’ re asking for a graduation requirement for a social justice class on anything that addresses race , class , or gender that are @ @ @ @ @ @ @ he said .
Online petitions , email templates , and board meetings : How students plan to stay involved Fighting for a more just and better education is a natural starting point for many young activists — especially for progressive-minded students who can trace the impact of required readings and classroom activities in their own development .
Parents , educators , and older community members have long dominated school board discourses , but younger advocates believe they , too , have the organizing skills and persistence to achieve their goals .
Bethlehem Wolde @ @ @ @ @ @ @ of Catonsville High School ’ s Black Student Union , participated in a panel on July 10 organized by Baltimore County ’ s public school system to discuss the need for more teacher diversity , bias training , and changes in curriculum .
“ I have a younger sister and younger cousins , ” she told me .
“ I don ’ t want them to experience microaggressions or be the only Black student in a high-level class .
I want them to be in a better learning environment , to learn more @ @ @ @ @ @ @ systemic disparities.
” For that to be possible , Wolde believes students of color need to have a seat at the table , which is why she has been active in organizing protests and speaking to educators and school leaders over the past several weeks .
Many other campaigns have started petitions or email templates to list out basic demands , urging students to actively reach out to their school boards , community leaders , and teachers .
Like Le and Haider pointed out , trying to institute massive , district-wide change will @ @ @ @ @ @ @ are starting with what seems doable for the coming school year , whether it ’ s pushing for changes to existing classes or making the case for additional ones in their schools .
This also means getting teachers on board .
The Diversify Our Narrative campaign , for example , calls for teachers to have greater autonomy in selecting texts that “ accurately [ portray ] the cultural and racial diversity ” of society .
This mindset also extends to ethnic studies .
Educators in Washington have started a campaign for ethnic studies @ @ @ @ @ @ @ learning series for interested teachers .
In Connecticut , Students for Educational Justice have established training programs focused on youth organizing for in-state students grades 8 to 12 and recent graduates .
In places where there ’ s already support for an ethnic studies framework , youth activists are hopeful that changes can be made by the fall .
“ Ethnic studies is already encouraged by California ’ s education department , ” said Dan Ma , a UC Berkeley junior and alumni of Westminster High School .
For a course to be @ @ @ @ @ @ @ proposal to the school and the district for approval .
Nearby high schools already work with Cal State Long Beach , a local university , to offer dual enrollment for certain cultural courses , or unique programs on Vietnamese history and environmental literature .
“ With dual enrollment , a student can travel to a different high school or college campus where a professor would teach the class , or alternatively , there ’ s an on-site class where the professor comes to your campus , ” he told me .
“ Regardless @ @ @ @ @ @ @ and energy going into this right now , so it should be possible to offer these classes district-wide over the next few years.
” But anti-racist advocates and educators don ’ t want these cultural histories to be simply siloed under the umbrella of ethnic studies .
“ If we want to address racism in society at large , we have to address it in policing , and housing , and health care — but we also need to address it in the third-grade music classroom , in the seventh-grade social studies classroom @ @ @ @ @ @ @ professor of ethnicity , race , and migration and American studies at Yale , told the Connecticut Mirror .
HoSang also co-founded the Anti-Racist Teaching and Learning Collective ( ARTLC ) , a network for Connecticut teachers seeking to diversify and expand their curriculum across many disciplines .
The program has helped educators rework their AP US history courses to center Indigenous peoples , teach international relations from a colonized group ’ s perspective , and create an art unit on Confederate monuments and their public reception , the Mirror reported .
Ultimately @ @ @ @ @ @ @ movement to change curriculum is only the beginning in tackling systemic racism in schools .
Haider and his fellow South Brunswick alumni are also calling attention to school policies that can hurt students of color , such as zero-tolerance discipline , heavy policing , and academic tracking .
“ What we want to do is take the restorative approach to rehabilitate the student to ensure they become better , ” he told me .
“ Studies show that suspensions can pave the way to the school-to-prison pipeline , and it ’ s basically @ @ @ @ @ @ @ t help the students.
” “ What we want to do is take the restorative approach to rehabilitate the student to ensure they become better ” While advocates have to be persistent and patient , taking action , especially in such a heated moment of racial reckoning , does pay off .
When 660 students and graduates penned an open letter in June asking the school board in Middletown , New Jersey , to address inequities in education , the superintendent responded .
The school board said it plans to partner with Monmouth @ @ @ @ @ @ @ inequities while considering ways to highlight the cultural contributions made by Native and Black Americans into its curriculum .
It also plans to develop a district-wide equity council with students , parents , and staff .
But regardless of what school administrators have pledged to do , many alumni and current students say they ’ re sticking around to make sure work is done — by continuing to show up to board meetings , circulate online petitions , call state representatives , and reach out to educators .
“ A lot of people @ @ @ @ @ @ @ t have the authority or power to do anything , ” Le said , “ but there are so many different campaigns and initiatives started by young people to try and change the high school curriculum .
I can ’ t vote yet , but this is one area I can confidently advocate for.
” Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never @ @ @ @ @ @ @ this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

Throughout her three years at Westminster High School in Southern California, Liana Le recalled reading only a handful of books that featured nonwhite perspectives. But even when those books featured people of color — in the case of To Kill a Mockingbird, for example — the 16-year-old realized that the book was often written by a white author who failed to portray Black characters with depth, agency, and thoughtfulness.
“It made me realize how representation in literature is so important,” the rising senior told me. “Talking about the Black, Latino, or Asian community from a removed point of view and reading it from a white author isn’t enough. We must include and hear other voices.”
In early June, Le discovered Diversify Our Narrative, a campaign spearheaded by California college students with the aim of introducing more diverse, anti-racist texts in America’s public school system. She is one of roughly 1,700 students across 200 school districts in the US to have signed up as a community organizer; she was then given tools and resources, like email templates and social media tips, to start a local petition targeting her community and school board.
Currently, Le and 17 others are working to present their proposal at Huntington Beach’s school board meeting on August 11. “We’re figuring out what we want to implement in the school curriculum since it’s such a new initiative,” Le said, “but we’re trying to start small and slowly inch our way up, while also trying to fundraise for new books.” The Diversify Our Narrative campaign has a recommended reading list of nonfiction and fiction titles Le hopes to draw from, featuring books like The Bluest Eye by Toni Morrison, There There by Tommy Orange, and Between the World and Me by Ta-Nehisi Coates.
Le and her peers are not alone in their efforts. As the country examines the systemic racism embedded in our institutions amid months of nationwide Black Lives Matter protests, high school students, alumni, and teachers across the country are petitioning their local governments and school boards to implement curriculum changes. This includes diversifying reading materials to include more writers of color, introducing ethnic studies programs, and expanding the scope of existing history classes. Many advocates have also drawn from their own classroom experiences to highlight other pressing issues beyond curriculum: the need for increased teacher diversity, initiatives to reduce the racial achievement gap in schools, and more lenient disciplinary policies when addressing students’ problematic behaviors.
In school districts from California to Texas to New Jersey, board leaders and administrators have been urged to acknowledge the systemic racism that persists in education. And while some have issued statements reaffirming their commitments to equity and inclusion, students realize that a curriculum overhaul could take time and, in some cases, receive political pushback.
Major curriculum change is tricky. Young activists want small changes while aiming for a larger overhaul.
Since the United States doesn’t have a national education system, states are largely responsible for setting certain educational goals and curricula for subjects like American history, math, and English. To make things easier, a majority of states since 2010 have adopted the Common Core standards, which were crafted by two national nonprofit groups to better measure students’ academic performance. Yet the Common Core appears to rely on classic, decades-old works — published primarily by white authors — to teach and assess students grades 6 to 12, according to the sample performance tests posted on its site.
At the high school level, some students also take a variety of Advanced Placement courses by the College Board, a not-for-profit organization that dominates the curriculum and testing market for most college-bound students. Since these classes tend to be structured quite rigidly to ensure students pass the end-of-year test, however, there’s little room for teachers to explore supplementary topics or readings. That’s a problem, critics say, especially when most of its history courses are heavily Eurocentric.
According to the Atlantic, the AP art history course, which was revised in 2016, still features about 65 percent of art within the Western tradition, with 35 percent hailing from “other artistic traditions.” When the College Board sought to revise its world history curriculum in 2018, it was criticized by students, professors, and the American Historical Association, who felt the proposed plan still placed too much emphasis on Western culture.
AP world history was developed in part to counter the Western focus of the AP’s other courses (US and European history), whose timelines began in 1450 CE and heavily emphasized the development of the European empires and colonization. The organization eventually addressed critics’ misgivings by changing the starting year of the world history class to 1200 CE and creating a second AP course that covers the previous 9,200 years of history.
The AP art history course, which was revised in 2016, still features about 65 percent of art within the Western tradition, with 35 percent hailing from “other artistic traditions”
The decision, however, didn’t necessarily resolve the debate as to what constitutes “world history,” or whether expanding the historical scope of the course would help students better understand human history.
As David M. Perry, a former professor of history, wrote in Pacific Standard, the AP’s world history focus shouldn’t be on dates or coverage over time. Rather, the class should be better organized, allowing teachers to select case studies and “choose a balanced array of diverse places and cultures on which to concentrate.”
Meanwhile, white authors and Eurocentric perspectives are still heavily overrepresented in most English and history courses across the country, too — regardless of student demographics. A 2018 analysis of New York City’s public school system of three popular elementary school resources found that authors of both fiction novels and curriculum materials are overwhelmingly white, despite the school system’s diverse student population (in the 2018-’19 academic year, NYC’s school system was 26 percent Black, 41 percent Hispanic, 16 percent Asian, and 15 percent white). NYU Steinhardt researchers in the report noted that studies show students are “more engaged in literature and history lessons, and more likely to have a positive perception of their ability to succeed in math and science” when they feel connected to learning content where their identities are reflected.
Relatedly, ethnic studies is another area where students are pushing to improve, or even initiate, curriculum. California, Vermont, and Oregon are among a handful of states that have set out to develop ethnic studies curriculums. In most states, however, these courses aren’t required — or even offered — in schools. But even in school systems with more students of color, many notice how ethnic studies courses are usually an afterthought or become the center of political controversy. In California’s proposed K-12 ethnic studies curriculum, materials focus on people of color, like Black Americans, Latinos, and Native Americans, according to the New York Times. Yet educators making these decisions have to grapple with questions of inclusion (Jews, Armenians, and Koreans felt they were left out) and whether the majority of teachers (who are white) are capable of teaching a subject they might be unfamiliar with.
Overhauling an entire state’s school system, let alone the centuries-old institution that is American education, is overwhelming, to say the least. For many advocates, the answer is baby steps. “Altering curriculum that’s already set in place, like AP courses, is going to be difficult,” Le told me. “We think it’ll be easier to implement changes at the freshman or sophomore levels [of high school], where there’s only honors or general-level classes, and we can fundraise for novels.”
Shajei Haider, a 2012 graduate of South Brunswick High School in New Jersey, said that he and a coalition of alumni are urging the school to bring back a defunct African American literature course, as well as introduce culturally relevant Black history into its traditional courses. In traditional English courses, students have said they’ve been taught books with outdated views on race, where teachers don’t provide proper context or even directly address modern-day racism.
Haider believes short-term changes are possible while pushing for longer-term solutions. For example, “we’re asking for a graduation requirement for a social justice class on anything that addresses race, class, or gender that are already on our class catalog,” he said.
Online petitions, email templates, and board meetings: How students plan to stay involved
Fighting for a more just and better education is a natural starting point for many young activists — especially for progressive-minded students who can trace the impact of required readings and classroom activities in their own development. Parents, educators, and older community members have long dominated school board discourses, but younger advocates believe they, too, have the organizing skills and persistence to achieve their goals.
Bethlehem Wolde, a rising senior and a member of Catonsville High School’s Black Student Union, participated in a panel on July 10 organized by Baltimore County’s public school system to discuss the need for more teacher diversity, bias training, and changes in curriculum. “I have a younger sister and younger cousins,” she told me. “I don’t want them to experience microaggressions or be the only Black student in a high-level class. I want them to be in a better learning environment, to learn more about Black history and be aware of systemic disparities.”
For that to be possible, Wolde believes students of color need to have a seat at the table, which is why she has been active in organizing protests and speaking to educators and school leaders over the past several weeks. Many other campaigns have started petitions or email templates to list out basic demands, urging students to actively reach out to their school boards, community leaders, and teachers.
Like Le and Haider pointed out, trying to institute massive, district-wide change will take some time, so many advocates are starting with what seems doable for the coming school year, whether it’s pushing for changes to existing classes or making the case for additional ones in their schools. This also means getting teachers on board. The Diversify Our Narrative campaign, for example, calls for teachers to have greater autonomy in selecting texts that “accurately [portray] the cultural and racial diversity” of society.
This mindset also extends to ethnic studies. Educators in Washington have started a campaign for ethnic studies in the state, offering their own learning series for interested teachers. In Connecticut, Students for Educational Justice have established training programs focused on youth organizing for in-state students grades 8 to 12 and recent graduates. In places where there’s already support for an ethnic studies framework, youth activists are hopeful that changes can be made by the fall.
“Ethnic studies is already encouraged by California’s education department,” said Dan Ma, a UC Berkeley junior and alumni of Westminster High School. For a course to be established, a teacher must submit a proposal to the school and the district for approval.
Nearby high schools already work with Cal State Long Beach, a local university, to offer dual enrollment for certain cultural courses, or unique programs on Vietnamese history and environmental literature.
“With dual enrollment, a student can travel to a different high school or college campus where a professor would teach the class, or alternatively, there’s an on-site class where the professor comes to your campus,” he told me. “Regardless, there’s so much power and energy going into this right now, so it should be possible to offer these classes district-wide over the next few years.”
But anti-racist advocates and educators don’t want these cultural histories to be simply siloed under the umbrella of ethnic studies. “If we want to address racism in society at large, we have to address it in policing, and housing, and health care — but we also need to address it in the third-grade music classroom, in the seventh-grade social studies classroom,” Daniel HoSang, an associate professor of ethnicity, race, and migration and American studies at Yale, told the Connecticut Mirror.
HoSang also co-founded the Anti-Racist Teaching and Learning Collective (ARTLC), a network for Connecticut teachers seeking to diversify and expand their curriculum across many disciplines. The program has helped educators rework their AP US history courses to center Indigenous peoples, teach international relations from a colonized group’s perspective, and create an art unit on Confederate monuments and their public reception, the Mirror reported.
Ultimately, for some student organizers, the movement to change curriculum is only the beginning in tackling systemic racism in schools. Haider and his fellow South Brunswick alumni are also calling attention to school policies that can hurt students of color, such as zero-tolerance discipline, heavy policing, and academic tracking. “What we want to do is take the restorative approach to rehabilitate the student to ensure they become better,” he told me. “Studies show that suspensions can pave the way to the school-to-prison pipeline, and it’s basically an ineffective punishment since it doesn’t help the students.”
“What we want to do is take the restorative approach to rehabilitate the student to ensure they become better”
While advocates have to be persistent and patient, taking action, especially in such a heated moment of racial reckoning, does pay off. When 660 students and graduates penned an open letter in June asking the school board in Middletown, New Jersey, to address inequities in education, the superintendent responded. The school board said it plans to partner with Monmouth and Rutgers University to work on the inequities while considering ways to highlight the cultural contributions made by Native and Black Americans into its curriculum. It also plans to develop a district-wide equity council with students, parents, and staff.
But regardless of what school administrators have pledged to do, many alumni and current students say they’re sticking around to make sure work is done — by continuing to show up to board meetings, circulate online petitions, call state representatives, and reach out to educators.
“A lot of people think that teenagers or students don’t have the authority or power to do anything,” Le said, “but there are so many different campaigns and initiatives started by young people to try and change the high school curriculum. I can’t vote yet, but this is one area I can confidently advocate for.”