vox--2020-12-15--The many strange long-term symptoms of Covid-19, explained

When Heather-Elizabeth Brown spiked a fever in April in Detroit , the only reason she was able to get a coronavirus test was because she was volunteering as a police chaplain and was therefore considered an essential worker .
Her results came back negative , and she was relieved .
But then , she says , “ I just got sicker and sicker.
” After being turned away from overcrowded ERs twice , Brown was eventually admitted on her third try .
She finally tested positive , and by that point , she was severely ill. She was put on @ @ @ @ @ @ @ days in a medically induced coma .
Before Covid-19 , Brown was a healthy , active Black woman in her 30s .
“ But when I came off the ventilator , they had to coach me how to breathe.
” The smallest pleasures — like eating a sliver of ice after her feeding tube was removed — became something to treasure .
Six months later , Brown is still very ill. She has been hospitalized for blood clots and has lingering heart problems , nerve pain , and extreme fatigue .
“ Even @ @ @ @ @ @ @ question , ” she says .
Most troublingly , she ’ s still experiencing severe brain fog , which makes it hard for her to return to work .
Brown is just one of many previously healthy people whose life has been derailed after a Covid-19 infection .
While early research on Covid-19 focused on its respiratory symptoms , we now know its impacts — both direct and indirect — can be much more extensive and relentless .
On December 3 , the National Institutes of Health held a two-day seminar on what @ @ @ @ @ @ @ , or long-haul Covid — cases of lingering symptoms that can last for weeks or months after an initial infection .
The Centers for Disease Control and Prevention ( CDC ) recently created a list of some of the persistent symptoms patients are experiencing , which include chest pain , brain fog , fatigue , and hair loss — with patients reporting many others as well .
Because these patients don ’ t all have the same symptoms , they will need different kinds of post-Covid care .
And the NIH made clear @ @ @ @ @ @ @ than answers — including whose symptoms might linger for months , and how to treat them .
Almost a year into the pandemic , there have not yet been thorough , large-scale studies to determine the true prevalence of long Covid .
But preliminary research suggests that somewhere between 10 percent and 88 percent of Covid-19 patients will experience at least one symptom for many weeks or months .
Some of these can be life-altering ; one study found that 50 percent of non-ICU patients reported a significant change to their cognitive functioning @ @ @ @ @ @ @ were surprised by the scope of long Covid and its potential socioeconomic impacts .
“ This is a phenomenon that is really quite real and quite extensive , ” said Anthony Fauci , director of the National Institute of Allergy and Infectious Diseases , who spoke at the event .
Even if the prevalence ends up being on the lower end of the 10 to 88 percent range , the sheer volume of people getting sick means there are already millions of Americans who have , and will soon have , long Covid @ @ @ @ @ @ @ we ’ re a hidden group of people , ” Brown says .
This can make getting treatment from skeptical physicians challenging .
Long-Covid patient Anthony Campbell , for example , had a doctor refuse to sign a work disability form unless he was treated for anxiety rather than for his persistent symptoms .
Interviews with dozens of patients like Brown and Campbell provide a closer look at long Covid ’ s devastating impact — and the clues the latest research offers into what might be causing all these symptoms , including erectile @ @ @ @ @ @ @ and dementia-like effects that can severely impact daily life .
One of the most surprising new findings about long Covid ’ s effects is that both women and men have reported sexual and reproductive system symptoms following a Covid-19 infection .
The Patient-Led Research Group , a team of researchers who are also Covid-19 patients , conducted a survey of 640 long-Covid patients and recorded more than 200 total symptoms , including testicular pain , urinary problems , and menstrual changes .
“ A lot of people with long Covid notice that their @ @ @ @ @ @ @ happens , ” when estrogen levels are lowest , says Louise Newson , a general practitioner and menopause specialist .
She says an additional sign hormones may be involved are long-Covid symptoms like “ brain fog , fatigue , dizziness , joint pain — these are also symptoms of menopause.
” Newson has 842 patient responses so far to a pilot survey , and she says the results “ confirm my thoughts that long Covid is likely to be related to low hormone levels ( estrogen and testosterone ) , which so far @ @ @ @ @ @ @ plays a key role in women ’ s health , and having abnormally low levels can lead to infertility , osteoporosis , lack of sex drive , and depression .
Newson says that anecdotally , patients with long Covid from her menopause clinic have improved with the right dose and type of hormone replacement therapy .
“ They all had low oestradiol and low testosterone results before treatment , ” she says .
Long Covid can also significantly impact male reproductive systems and testosterone levels .
“ Absolutely , reproductive systems have been @ @ @ @ @ @ @ Geoff Hackett , a professor of sexual medicine at Aston University in Birmingham , UK .
He explains that during acute illness , the testes can be attacked by the virus directly .
“ The testes are one of the highest sites of ACE2 expression , ” writes the British Society of Sexual Medicine ( BSSM ) in its position paper on Covid-19 .
( This ACE2 enzyme is the primary way SARS-CoV-2 enters cells . )
The BSSM adds that SARS-CoV-2 also damages cells on the inner surface of blood vessels called @ @ @ @ @ @ @ “ frequently present in men with erectile dysfunction and testosterone deficiency.
” Several recent studies have pointed to testosterone , which in men is produced in the testes , as playing an important role in coronavirus patients : A study in Germany found that the majority of men admitted to the hospital with Covid-19 had low testosterone levels and high inflammatory markers .
( This study was unable to determine if these low testosterone levels predated their coronavirus infection . )
A similar study in Italy found low testosterone levels predicted worse outcomes @ @ @ @ @ @ @ , in Wuhan , China , also found low testosterone levels in coronavirus patients , which they said required “ more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection , especially the reproductive-aged men.
” Hypogonadism , when sex organs don ’ t produce sufficient hormones , affects both the production of testosterone and sperm .
Another recent paper , published in The Lancet , found the production of sperm was impaired in Covid-19 patients , which they said might be explained by an immune response in the testes .
@ @ @ @ @ @ @ auto-immune orchitis , or inflammation of the testis with specific anti-sperm antibodies .
“ There does seem to be some evidence for relative infertility afterward , ” Hackett says , though he cautions it ’ s too early to say if it would be permanent .
In general , “ attacking the cells of the testes will have an adverse effect on erections , ” Hackett says .
Even beyond a direct effect , endothelial disorder and inflammation may affect the arteries in the penis , making erections more difficult .
“ Erectile @ @ @ @ @ @ @ , particularly if you look at the groups at high risk of Covid-19 , ” Hackett says .
“ Seventy-five percent of diabetics have erectile dysfunction anyway.
” Based on anecdotal evidence , the next Patient-Led Research Group survey will include questions on shrinkage , erectile dysfunction , and testicular pain .
Erectile function is a sign of overall health , and urologist Ryan Berglund of the Cleveland Clinic recently made a statement that for young and healthy people who develop this problem after having Covid-19 , “ this can be a sign @ @ @ @ @ @ @ The BSSM is concerned that these reproductive effects may have lasting implications , warning that low testosterone levels in men “ are associated with increased mortality , ” and that those “ who may have survived the current pandemic ... may be at considerable risk from second and third wave infection , or future viral pandemics.
” Beyond Covid-19 , research suggested a connection between viral infections of the central nervous system and pituitary dysfunction .
A significant number of viruses have previously been associated with the onset of Type 1 diabetes , @ @ @ @ @ @ @ an increase in diabetes diagnoses during the pandemic .
Recognizing these impacts may help doctors find effective treatments ; Hackett says a common erectile dysfunction treatment , Tadalafil , improves all markers of endothelial disease .
“ If it didn ’ t give men an erection , it would be treated as a serious cardiovascular drug , ” he says .
He notes that mountain climbers often take Tadalafil before big climbs to avoid altitude sickness , as it lowers pulmonary artery pressure and improves the endothelium of arteries — effects that might @ @ @ @ @ @ @ says even as the UK National Health System rolls out long-Covid clinics , he ’ s been disappointed to see these symptoms overlooked .
“ Their strategies include things like eating healthy , hydrating , and mindfulness , ” he says .
“ How is this going to go down with seriously ill people ?
All they ’ re offering is platitudes.
” Long-Covid symptoms can be very diverse and are often not limited to one part of the body , making them hard to understand .
One of the reasons long-Covid patients @ @ @ @ @ @ @ their illnesses , says Hannah Davis , a long-Covid patient and a member of the Patient-Led Research Group who helped design the survey , “ is that we need answers.
” She ’ s tired of being told that no one knows how to help treat her symptoms , or how many others might be experiencing something similar .
“ We ’ re going to get answers faster than anyone else because we ’ re living this experience , ” Davis says .
One recent study of 201 long-Covid patients in the UK @ @ @ @ @ @ @ low-risk population , 66 percent had impairments to one or more organs four months after their initial symptoms .
Being sick enough to be ventilated , like Brown was , often comes with its own complications ; one study found that 81 percent of ventilated patients develop delirium , and one in five patients with acute respiratory distress syndrome — a common lung condition in ICU patients — experience long-term cognitive impairment .
But even coronavirus patients with milder symptoms or no initial symptoms at all can develop long Covid .
Long-term lung @ @ @ @ @ @ @ symptom , as the virus can directly inflame the lung tissue , filling air sacs with fluid and making them less elastic and harder to expand as you breathe .
Even at the beginning of the pandemic , it was known that previous coronavirus epidemics had caused lung scarring in some patients .
One 15-year study of 71 SARS patients from a 2003 outbreak found a third had reduced lung capacity ; a third of MERS survivors in a 2017 study also had long-term lung damage .
New research suggests that around half @ @ @ @ @ @ @ damage to the lungs .
In early November , a study published in The Lancet on 41 autopsies of Covid-19 patients offered a possible reason : It found that the virus caused major structural changes in the lungs , including extensive blood clotting , scarring of respiratory tissue , and the fusion of many smaller cells into larger cells .
( Based on the fact that these were autopsies , these were all severe cases , limiting the implications that can be drawn . )
The authors suggest that , unlike other types @ @ @ @ @ @ @ stem “ from the persistence of infected and dysfunctional cells in the lungs ” — which may help explain why some of these symptoms linger .
Though we still don ’ t know the exact mechanics , continuing lung symptoms are perhaps the most common of them .
It ’ s still unclear how long these symptoms might last ; some long-Covid patients have reported improvements in their breathing , although much slower than they would have liked .
One study of mildly ill patients in China found that 70 percent had abnormal @ @ @ @ @ @ @ illness .
Early in the pandemic , doctors noticed that many Covid-19 patients were having serious blood clotting problems , with reports of clogging dialysis machines and clots in the arms and legs called deep vein thromboses .
But some patients , like Brown — who went back to the hospital with blood clots three months after her initial symptoms — are also experiencing clots weeks or months later .
Large blood clots can cause tissue damage , requiring amputations .
Smaller clots can restrict blood flow in the lungs , impairing normal @ @ @ @ @ @ @ the brain or heart , they can also cause strokes or heart attacks , as 23-year-old Riley Behrens recently suffered after a coronavirus infection .
“ Before this , I was a healthy young athlete with no major medical conditions , ” she tweeted after a Covid-related stroke .
“ Now , I ’ m being told I will likely never return to contact sports because of lasting lung and brain damage .
The risk for a second stroke will always be there.
” It ’ s hard to know how common clotting @ @ @ @ @ @ @ reports of conditions linked to clotting have certainly increased : A study published in Annals of Vascular Surgery recently found a twofold increase during the pandemic in major amputations , which are sometimes required after a clot is found .
And multiple researchers have reported a spike in the number of stroke patients , including young people like Behrens who would not normally be at high risk for strokes , as well as in patients who didn ’ t know they ’ d had the coronavirus but later tested positive for antibodies .
@ @ @ @ @ @ @ may have identified one of the reasons for this abnormal clotting : In half of 172 hospitalized coronavirus patients , the scientists found autoantibodies — proteins that are supposed to defend against invaders that instead start to attack the body ’ s own cells .
When these autoantibodies were injected into lab mice , the animals developed blood clots .
The researchers suggest that these proteins could be sparking a dangerous loop between clotting and hyperinflammation .
A December preprint also found a significant percentage of Covid-19 patients developed autoantibodies , and the @ @ @ @ @ @ @ autoantibodies they had .
But Covid-19 ’ s cardiovascular impacts don ’ t end with coagulation .
Half of 1,216 Covid-19 patients in one study also had heart abnormalities , and one in seven had severe cardiac issues .
“ People can present without any lung symptoms , and have just heart or brain involvement , ” says Eric Topol , a professor of molecular medicine and director of the Scripps Research Translational Institute .
These can include cardiomyopathy , a disease of the heart muscle that makes it harder for your heart @ @ @ @ @ @ @ of the heart muscle ; and pericarditis , inflammation of the pericardium , the two thin layers of tissue that surround the heart and help it function .
One study on 54 college athletes who ’ d had mild Covid-19 cases found that a third had pericarditis , even though about the same number had been asymptomatic .
Many long-Covid patients are also experiencing persistent heart concerns months after their initial illness .
Kate Meredith of Beverly , Massachusetts , for example , first got sick in March .
Now , she has @ @ @ @ @ @ @ rate .
“ If I get up to do the dishes , it jumps to 140 [ beats per minute ] , ” she says .
Leticia Soares and Israel Slick , of Ontario , both also got Covid-19 in April .
They each independently reported heart palpitations and tachycardia to the same doctor , who speculated Slick ’ s condition might be related to his Covid-19 infection , while Soares , who is Latina , was told to seek counseling .
( Many Black and brown long-Covid patients say they ’ ve @ @ @ @ @ @ @ try to seek treatment . )
Cardiovascular symptoms may arise from the coronavirus directly impacting the endothelium .
These cells control vascular functions , including enzymes that direct blood clotting .
The endothelium is also important for proper immune function , and its imbalance could help explain the cytokine storms seen in many patients with severe Covid-19 cases .
“ There ’ s no shortage of ways by which this virus can hurt the heart , ” Topol concludes .
Damaged endothelial cells can also stimulate mast cells , a type of blood @ @ @ @ @ @ @ immune system .
Their job is to defend against foreign bodies by releasing chemicals like histamines .
Activated mast cells were recently found in autopsies of Covid-19 patients and are linked to clots and pulmonary edemas .
Some long-Covid patients are reporting symptoms and inflammation similar to mast cell activation syndrome ( MCAS ) , a chronic , multisystem condition that causes allergic responses , GI problems , and neurological issues .
Frances Simpson , a psychology lecturer at Coventry University in the UK , says she and her 5- and 9-year old @ @ @ @ @ @ @ have had long-Covid symptoms since , including new allergic reactions .
“ When you read about possible mast cell activation syndrome , ” she says , “ we can tick all of the symptoms off between us ” — things like headaches , rashes , and extreme fatigue .
Moreover , some of the drugs that have been shown to help with severe Covid-19 cases , like famotidine and aspirin , inhibit mast cell activation .
Immunology is very complicated , but it also appears that T cells , an important component of @ @ @ @ @ @ @ a role in long Covid , as they do in other inflammatory and autoimmune conditions .
The CDC is now calling a particular set of inflammatory symptoms in multiple organs after an initial infection multisystem inflammatory syndrome in adults , or MIS-A — after a similar post-viral condition that was first reported in children , called MIS-C .
Both children ’ s and adults ’ symptoms in these cases overlap with MCAS , with problems like chest tightness , abdominal pain , rash , and inflammation , strengthening the argument that mast cells @ @ @ @ @ @ @ also homing in on the many , sometimes severe , neurological symptoms that long-Covid patients have reported .
One peer-reviewed paper found that a surprising 40 percent of patients with Covid-19 showed some kind of neurologic manifestation , and more than 30 percent had impaired cognition .
These symptoms — including brain fog , extreme fatigue , difficulty with short-term memory , intense headaches , and tingling or numbness — are common in long-Covid patients .
Some long-Covid patients develop dysautonomia , a disorder of the autonomic nervous system that can be triggered @ @ @ @ @ @ @ system controls involuntary functions in our bodies such as heart rate and digestion .
When it is damaged by an infection , these functions can go out of whack .
Davis , for example , has been diagnosed with a form of dysautonomia called postural orthostatic tachycardia syndrome ( POTS ) , where blood vessels don ’ t respond to chemical signals efficiently .
When she stands , blood pools in her lower extremities , making her feel faint and exacerbating her brain fog .
The nervous system continues to release hormones to @ @ @ @ @ @ @ her heart rate and making her shake .
There ’ s also increasing evidence that SARS-CoV-2 can actually cross the blood-brain barrier , a layer of specialized cells that protect the brain , and harm the nervous system directly .
In April , researchers found that a 40-year-old woman in Los Angeles with headaches , seizures , and hallucinations had RNA from the coronavirus in her cerebrospinal fluid .
One study recently found an explanation for how that may have occurred : The virus can directly enter and damage cells in the brain @ @ @ @ @ @ @ cells with ACE2 receptors .
“ This can lead to leakage across this important barrier , that normally prevents entry of pathogens into the cerebrospinal fluid and the brain , ” says study co-author Madeline Lancaster , a biologist and the group leader at the MRC Laboratory of Molecular Biology in Cambridge , UK .
The brain is normally protected from your blood , so it ’ s a big problem to have that barrier penetrated .
During viral infections , many immune cells are activated and circulating through the body .
Lancaster @ @ @ @ @ @ @ doesn ’ t get past the barrier , having “ those inflammatory cytokines leak into the brain , where they really do not belong , can have serious repercussions.
” One example is encephalitis , or inflammation of the brain itself , as found in this study of 12 Covid-19 patients in the UK .
Lancaster says viruses may penetrate the blood-brain barrier more often than previously thought .
“ The Covid crisis has shined a light on overlooked post-viral chronic fatigue syndrome ( CFS ) , ” she says .
“ There @ @ @ @ @ @ @ inflammation of the brain can lead to those symptoms .
There ’ s a huge overlap between those conditions and long Covid.
” But though post-viral symptoms may linger for months or even years , it can be hard for doctors to find clues in neurological tests .
While encephalitis can be seen on MRIs , damage to the cerebrospinal fluid might not be visible .
( Doctors can , however , look for elevated biomarkers like cytokines . )
“ Unfortunately , that ’ s one of the reasons a lot of @ @ @ @ @ @ @ ’ s all in their heads .
We ’ ve let those patients down , ” says Lancaster .
Neuro-inflammation can cause emotional and behavioral changes .
Sammie , who asked that her last name not be used to protect her privacy , says she and her daughter were both infected in the UK with Covid-19 in March .
Since then , her 15-year-old daughter has had headaches , dysautonomia , fatigue , and extreme anxiety and emotional outbursts .
“ She ’ s not a crier .
She ’ s normally very @ @ @ @ @ @ @ over the last few months , “ she ’ s had irrational outbursts , just sobbing her heart out.
” One study of 62,354 patients recently published in The Lancet Psychiatry journal found that one in five were diagnosed with a mental health disorder within three months of testing positive for the coronavirus .
“ But what ’ s the chicken and what ’ s the egg ?
” Lancaster asks .
“ It could be that there are people with leakier brains to start with , who when they get Covid-19 are @ @ @ @ @ @ @ their brain.
” Neuro-inflammation might also help explain some of the weirder long-Covid symptoms reported by parents of children who have had Covid-19 , like something called Alice in Wonderland syndrome , an alteration of visual perception where objects or body part sizes are perceived incorrectly .
Simpson says her son ’ s vision regularly goes blurry , and he describes people ’ s heads “ going small.
” Gretchen Drown of Portland , Maine , also says that her 15-year old son , who got Covid-19 in March , describes “ things @ @ @ @ @ @ @ these episodes , his pupils get strangely dilated .
Drown ’ s son also now has headaches and extreme fatigue , which worsen after he overexerts himself , making it hard to keep up with school .
Damaging the blood-brain barrier also hurts its ability to make cerebrospinal fluid , which is important for providing nutrients to the brain and removing its normal waste .
Lancaster calls the cerebrospinal fluid the plumbing system of the brain .
“ Imagine your house with all your toilets clogged — a similar thing can happen in @ @ @ @ @ @ @ Much of this fluid cycling normally occurs during sleep , so Lancaster suggests that Alice in Wonderland syndrome — and possibly other common neurological symptoms in long Covid , like extreme fatigue and insomnia — might be related to the virus compromising the body ’ s ability to generate and manage this fluid .
As the pandemic began , it appeared most children had mild cases of Covid-19 .
But while clinicians have not been tracking long Covid in children , it ’ s clear from the many parents Vox interviewed that children @ @ @ @ @ @ @ persistent symptoms that can completely alter their ability to function .
That no one seems to be paying attention to pediatric long-Covid cases is a source of extreme frustration .
Multiple parents reported that during their efforts to get their children care , medical providers accused them of Munchausen syndrome , a psychological disorder where someone pretends to be ill. Sammie says when a nurse suggested it to her , “ I literally think if I hadn ’ t had a mask on , my jaw would have fallen off .
I felt @ @ @ @ @ @ @ emotional talking about it now.
” Since then , she ’ s complained to the clinic and actually gotten a letter of apology .
But her experience demonstrates the hurdles parents face in getting their children the care they need .
“ I think there are a lot more children who are ill , and who no one is connecting the dots for , ” Sammie says .
While it ’ s hard to quantify something no one is tracking , the American Academy of Pediatrics suggests about 11 percent of US Covid-19 @ @ @ @ @ @ @ children contracting the virus as of December 3 .
It ’ s easier to count more acute Covid-19 consequences , like MIS-C : In one study of kids under 18 with MIS-C , 14.8 percent exhibited new neurological symptoms like headaches , muscle weakness , and reduced reflexes .
The youngest child with persistent symptoms Vox found was 18 months ; the oldest was 15 .
While some of the symptoms parents have reported in children are similar to adult long-Covid cases — headaches , extreme fatigue , difficulty concentrating or forming new @ @ @ @ @ @ @ , dysautonomia , lingering or recurrent fevers — others differ .
Some parents in the long-Covid kids online group Sammie formed , for example , have been reporting frequent nosebleeds .
Some of the parents , like Simpson , are themselves suffering from long Covid .
“ In many families who have kids with long Covid , there ’ s a mother or father who has it as well .
People should be tripping over themselves to research if this is genetic , ” she says .
But in the meantime , for @ @ @ @ @ @ @ , and Drown , there are few resources to help their children recover .
Though it hasn ’ t been easy , Sammie hasn ’ t given up trying to get her daughter into more specialized care .
“ If I don ’ t advocate for my child , who the hell is going to do it ?
” she asks .
Parents worry about how their children ’ s lives might be impacted by the long-term effects of this disease .
For adult patients , too , the repercussions are potentially huge @ @ @ @ @ @ @ that her name be withheld for privacy reasons , first got sick this spring .
She eventually despaired of finding treatment for her long-Covid symptoms .
She recently drove to New York — because she wanted to be near the best researchers she knew of — before ending her life .
She donated her body to science .
For those who survive , like Brown , the questions are pervasive .
“ How will this affect me when I want to have a baby ?
” Brown asks .
“ What is next @ @ @ @ @ @ @ one can tell me anything specific.
” She ’ s frustrated that friends her age still assume that if they get infected , they ’ ll recover .
“ You might be okay , but you might not , ” Brown says .
She says she ’ s angry about how the pandemic has been measured in deaths rather than in lives disrupted .
“ The disparities are shocking .
And more will be lost if we don ’ t make adjustments.
” Lois Parshley is a freelance investigative journalist .
Follow her @ @ @ @ @ @ @

When Heather-Elizabeth Brown spiked a fever in April in Detroit, the only reason she was able to get a coronavirus test was because she was volunteering as a police chaplain and was therefore considered an essential worker. Her results came back negative, and she was relieved. But then, she says, “I just got sicker and sicker.”
After being turned away from overcrowded ERs twice, Brown was eventually admitted on her third try. She finally tested positive, and by that point, she was severely ill. She was put on a ventilator and spent the next 31 days in a medically induced coma.
Before Covid-19, Brown was a healthy, active Black woman in her 30s. “But when I came off the ventilator, they had to coach me how to breathe.” The smallest pleasures — like eating a sliver of ice after her feeding tube was removed — became something to treasure.
Six months later, Brown is still very ill. She has been hospitalized for blood clots and has lingering heart problems, nerve pain, and extreme fatigue. “Even making breakfast is now out of the question,” she says. Most troublingly, she’s still experiencing severe brain fog, which makes it hard for her to return to work.
Brown is just one of many previously healthy people whose life has been derailed after a Covid-19 infection. While early research on Covid-19 focused on its respiratory symptoms, we now know its impacts — both direct and indirect — can be much more extensive and relentless.
On December 3, the National Institutes of Health held a two-day seminar on what has come to be called long Covid, or long-haul Covid — cases of lingering symptoms that can last for weeks or months after an initial infection. The Centers for Disease Control and Prevention (CDC) recently created a list of some of the persistent symptoms patients are experiencing, which include chest pain, brain fog, fatigue, and hair loss — with patients reporting many others as well.
Because these patients don’t all have the same symptoms, they will need different kinds of post-Covid care. And the NIH made clear that there are still many more questions than answers — including whose symptoms might linger for months, and how to treat them.
Almost a year into the pandemic, there have not yet been thorough, large-scale studies to determine the true prevalence of long Covid. But preliminary research suggests that somewhere between 10 percent and 88 percent of Covid-19 patients will experience at least one symptom for many weeks or months. Some of these can be life-altering; one study found that 50 percent of non-ICU patients reported a significant change to their cognitive functioning.
Doctors at the seminar said they were surprised by the scope of long Covid and its potential socioeconomic impacts. “This is a phenomenon that is really quite real and quite extensive,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who spoke at the event.
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Even if the prevalence ends up being on the lower end of the 10 to 88 percent range, the sheer volume of people getting sick means there are already millions of Americans who have, and will soon have, long Covid. Despite the staggering numbers, “we’re a hidden group of people,” Brown says. This can make getting treatment from skeptical physicians challenging. Long-Covid patient Anthony Campbell, for example, had a doctor refuse to sign a work disability form unless he was treated for anxiety rather than for his persistent symptoms.
Interviews with dozens of patients like Brown and Campbell provide a closer look at long Covid’s devastating impact — and the clues the latest research offers into what might be causing all these symptoms, including erectile dysfunction, hormonal imbalances, hallucinations, and dementia-like effects that can severely impact daily life.
Menstrual changes and erectile dysfunction
One of the most surprising new findings about long Covid’s effects is that both women and men have reported sexual and reproductive system symptoms following a Covid-19 infection.
The Patient-Led Research Group, a team of researchers who are also Covid-19 patients, conducted a survey of 640 long-Covid patients and recorded more than 200 total symptoms, including testicular pain, urinary problems, and menstrual changes.
“A lot of people with long Covid notice that their symptoms get worse just before their period happens,” when estrogen levels are lowest, says Louise Newson, a general practitioner and menopause specialist. She says an additional sign hormones may be involved are long-Covid symptoms like “brain fog, fatigue, dizziness, joint pain — these are also symptoms of menopause.”
Newson has 842 patient responses so far to a pilot survey, and she says the results “confirm my thoughts that long Covid is likely to be related to low hormone levels (estrogen and testosterone), which so far have been neglected with research.” Estrogen plays a key role in women’s health, and having abnormally low levels can lead to infertility, osteoporosis, lack of sex drive, and depression.
Newson says that anecdotally, patients with long Covid from her menopause clinic have improved with the right dose and type of hormone replacement therapy. “They all had low oestradiol and low testosterone results before treatment,” she says.
Long Covid can also significantly impact male reproductive systems and testosterone levels. “Absolutely, reproductive systems have been overlooked during the pandemic,” says Geoff Hackett, a professor of sexual medicine at Aston University in Birmingham, UK. He explains that during acute illness, the testes can be attacked by the virus directly.
“The testes are one of the highest sites of ACE2 expression,” writes the British Society of Sexual Medicine (BSSM) in its position paper on Covid-19. (This ACE2 enzyme is the primary way SARS-CoV-2 enters cells.) The BSSM adds that SARS-CoV-2 also damages cells on the inner surface of blood vessels called endothelial cells, a condition which is “frequently present in men with erectile dysfunction and testosterone deficiency.”
Several recent studies have pointed to testosterone, which in men is produced in the testes, as playing an important role in coronavirus patients: A study in Germany found that the majority of men admitted to the hospital with Covid-19 had low testosterone levels and high inflammatory markers. (This study was unable to determine if these low testosterone levels predated their coronavirus infection.)
A similar study in Italy found low testosterone levels predicted worse outcomes in hospitalized patients. A third study, in Wuhan, China, also found low testosterone levels in coronavirus patients, which they said required “more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection, especially the reproductive-aged men.”
Hypogonadism, when sex organs don’t produce sufficient hormones, affects both the production of testosterone and sperm. Another recent paper, published in The Lancet, found the production of sperm was impaired in Covid-19 patients, which they said might be explained by an immune response in the testes. In some patients, they also found auto-immune orchitis, or inflammation of the testis with specific anti-sperm antibodies. “There does seem to be some evidence for relative infertility afterward,” Hackett says, though he cautions it’s too early to say if it would be permanent.
In general, “attacking the cells of the testes will have an adverse effect on erections,” Hackett says. Even beyond a direct effect, endothelial disorder and inflammation may affect the arteries in the penis, making erections more difficult. “Erectile dysfunction is going to be highly prevalent, particularly if you look at the groups at high risk of Covid-19,” Hackett says. “Seventy-five percent of diabetics have erectile dysfunction anyway.” Based on anecdotal evidence, the next Patient-Led Research Group survey will include questions on shrinkage, erectile dysfunction, and testicular pain.
Erectile function is a sign of overall health, and urologist Ryan Berglund of the Cleveland Clinic recently made a statement that for young and healthy people who develop this problem after having Covid-19, “this can be a sign of something more serious going on.”
The BSSM is concerned that these reproductive effects may have lasting implications, warning that low testosterone levels in men “are associated with increased mortality,” and that those “who may have survived the current pandemic ... may be at considerable risk from second and third wave infection, or future viral pandemics.”
Beyond Covid-19, research suggested a connection between viral infections of the central nervous system and pituitary dysfunction. A significant number of viruses have previously been associated with the onset of Type 1 diabetes, and it appears there may have been an increase in diabetes diagnoses during the pandemic.
Recognizing these impacts may help doctors find effective treatments; Hackett says a common erectile dysfunction treatment, Tadalafil, improves all markers of endothelial disease. “If it didn’t give men an erection, it would be treated as a serious cardiovascular drug,” he says. He notes that mountain climbers often take Tadalafil before big climbs to avoid altitude sickness, as it lowers pulmonary artery pressure and improves the endothelium of arteries — effects that might significantly help Covid-19 patients.
But Hackett says even as the UK National Health System rolls out long-Covid clinics, he’s been disappointed to see these symptoms overlooked. “Their strategies include things like eating healthy, hydrating, and mindfulness,” he says. “How is this going to go down with seriously ill people? All they’re offering is platitudes.”
Pulmonary problems
Long-Covid symptoms can be very diverse and are often not limited to one part of the body, making them hard to understand. One of the reasons long-Covid patients are struggling to do high-quality research through their illnesses, says Hannah Davis, a long-Covid patient and a member of the Patient-Led Research Group who helped design the survey, “is that we need answers.”
She’s tired of being told that no one knows how to help treat her symptoms, or how many others might be experiencing something similar. “We’re going to get answers faster than anyone else because we’re living this experience,” Davis says. One recent study of 201 long-Covid patients in the UK found that even in a young, low-risk population, 66 percent had impairments to one or more organs four months after their initial symptoms.
Being sick enough to be ventilated, like Brown was, often comes with its own complications; one study found that 81 percent of ventilated patients develop delirium, and one in five patients with acute respiratory distress syndrome — a common lung condition in ICU patients — experience long-term cognitive impairment. But even coronavirus patients with milder symptoms or no initial symptoms at all can develop long Covid.
Long-term lung problems are perhaps the most straightforward long-Covid symptom, as the virus can directly inflame the lung tissue, filling air sacs with fluid and making them less elastic and harder to expand as you breathe. Even at the beginning of the pandemic, it was known that previous coronavirus epidemics had caused lung scarring in some patients. One 15-year study of 71 SARS patients from a 2003 outbreak found a third had reduced lung capacity; a third of MERS survivors in a 2017 study also had long-term lung damage.
New research suggests that around half of asymptomatic Covid-19 infections can also cause damage to the lungs.
In early November, a study published in The Lancet on 41 autopsies of Covid-19 patients offered a possible reason: It found that the virus caused major structural changes in the lungs, including extensive blood clotting, scarring of respiratory tissue, and the fusion of many smaller cells into larger cells. (Based on the fact that these were autopsies, these were all severe cases, limiting the implications that can be drawn.)
The authors suggest that, unlike other types of pneumonia, these structural changes may stem “from the persistence of infected and dysfunctional cells in the lungs” — which may help explain why some of these symptoms linger. Though we still don’t know the exact mechanics, continuing lung symptoms are perhaps the most common of them.
It’s still unclear how long these symptoms might last; some long-Covid patients have reported improvements in their breathing, although much slower than they would have liked. One study of mildly ill patients in China found that 70 percent had abnormal lung scans three months after their initial illness.
Blood clotting and other cardiovascular issues
Early in the pandemic, doctors noticed that many Covid-19 patients were having serious blood clotting problems, with reports of clogging dialysis machines and clots in the arms and legs called deep vein thromboses. But some patients, like Brown — who went back to the hospital with blood clots three months after her initial symptoms — are also experiencing clots weeks or months later.
Large blood clots can cause tissue damage, requiring amputations. Smaller clots can restrict blood flow in the lungs, impairing normal oxygen exchange. If clots travel to the brain or heart, they can also cause strokes or heart attacks, as 23-year-old Riley Behrens recently suffered after a coronavirus infection. “Before this, I was a healthy young athlete with no major medical conditions,” she tweeted after a Covid-related stroke. “Now, I’m being told I will likely never return to contact sports because of lasting lung and brain damage. The risk for a second stroke will always be there.”
It’s hard to know how common clotting problems are in Covid-19 patients, but reports of conditions linked to clotting have certainly increased: A study published in Annals of Vascular Surgery recently found a twofold increase during the pandemic in major amputations, which are sometimes required after a clot is found. And multiple researchers have reported a spike in the number of stroke patients, including young people like Behrens who would not normally be at high risk for strokes, as well as in patients who didn’t know they’d had the coronavirus but later tested positive for antibodies.
A study published in Science in mid-November may have identified one of the reasons for this abnormal clotting: In half of 172 hospitalized coronavirus patients, the scientists found autoantibodies — proteins that are supposed to defend against invaders that instead start to attack the body’s own cells. When these autoantibodies were injected into lab mice, the animals developed blood clots. The researchers suggest that these proteins could be sparking a dangerous loop between clotting and hyperinflammation. A December preprint also found a significant percentage of Covid-19 patients developed autoantibodies, and the more severe their symptoms, the more autoantibodies they had.
But Covid-19’s cardiovascular impacts don’t end with coagulation. Half of 1,216 Covid-19 patients in one study also had heart abnormalities, and one in seven had severe cardiac issues.
“People can present without any lung symptoms, and have just heart or brain involvement,” says Eric Topol, a professor of molecular medicine and director of the Scripps Research Translational Institute. These can include cardiomyopathy, a disease of the heart muscle that makes it harder for your heart to pump; myocarditis, or inflammation of the heart muscle; and pericarditis, inflammation of the pericardium, the two thin layers of tissue that surround the heart and help it function. One study on 54 college athletes who’d had mild Covid-19 cases found that a third had pericarditis, even though about the same number had been asymptomatic.
Many long-Covid patients are also experiencing persistent heart concerns months after their initial illness. Kate Meredith of Beverly, Massachusetts, for example, first got sick in March. Now, she has tachycardia, or an abnormally elevated heart rate. “If I get up to do the dishes, it jumps to 140 [beats per minute],” she says.
Leticia Soares and Israel Slick, of Ontario, both also got Covid-19 in April. They each independently reported heart palpitations and tachycardia to the same doctor, who speculated Slick’s condition might be related to his Covid-19 infection, while Soares, who is Latina, was told to seek counseling. (Many Black and brown long-Covid patients say they’ve experienced gaslighting and medical racism when they try to seek treatment.)
Cardiovascular symptoms may arise from the coronavirus directly impacting the endothelium. These cells control vascular functions, including enzymes that direct blood clotting. The endothelium is also important for proper immune function, and its imbalance could help explain the cytokine storms seen in many patients with severe Covid-19 cases. “There’s no shortage of ways by which this virus can hurt the heart,” Topol concludes.
Immune system
Damaged endothelial cells can also stimulate mast cells, a type of blood cell that’s part of the immune system. Their job is to defend against foreign bodies by releasing chemicals like histamines. Activated mast cells were recently found in autopsies of Covid-19 patients and are linked to clots and pulmonary edemas.
Some long-Covid patients are reporting symptoms and inflammation similar to mast cell activation syndrome (MCAS), a chronic, multisystem condition that causes allergic responses, GI problems, and neurological issues.
Frances Simpson, a psychology lecturer at Coventry University in the UK, says she and her 5- and 9-year old were infected with Covid-19 in March and have had long-Covid symptoms since, including new allergic reactions. “When you read about possible mast cell activation syndrome,” she says, “we can tick all of the symptoms off between us” — things like headaches, rashes, and extreme fatigue. Moreover, some of the drugs that have been shown to help with severe Covid-19 cases, like famotidine and aspirin, inhibit mast cell activation.
Immunology is very complicated, but it also appears that T cells, an important component of the immune system, may also play a role in long Covid, as they do in other inflammatory and autoimmune conditions.
The CDC is now calling a particular set of inflammatory symptoms in multiple organs after an initial infection multisystem inflammatory syndrome in adults, or MIS-A — after a similar post-viral condition that was first reported in children, called MIS-C. Both children’s and adults’ symptoms in these cases overlap with MCAS, with problems like chest tightness, abdominal pain, rash, and inflammation, strengthening the argument that mast cells may be involved.
Nervous system
New research is also homing in on the many, sometimes severe, neurological symptoms that long-Covid patients have reported. One peer-reviewed paper found that a surprising 40 percent of patients with Covid-19 showed some kind of neurologic manifestation, and more than 30 percent had impaired cognition. These symptoms — including brain fog, extreme fatigue, difficulty with short-term memory, intense headaches, and tingling or numbness — are common in long-Covid patients.
Some long-Covid patients develop dysautonomia, a disorder of the autonomic nervous system that can be triggered by viral infections. The autonomic nervous system controls involuntary functions in our bodies such as heart rate and digestion. When it is damaged by an infection, these functions can go out of whack.
Davis, for example, has been diagnosed with a form of dysautonomia called postural orthostatic tachycardia syndrome (POTS), where blood vessels don’t respond to chemical signals efficiently. When she stands, blood pools in her lower extremities, making her feel faint and exacerbating her brain fog. The nervous system continues to release hormones to tighten her non-responding blood vessels, increasing her heart rate and making her shake.
There’s also increasing evidence that SARS-CoV-2 can actually cross the blood-brain barrier, a layer of specialized cells that protect the brain, and harm the nervous system directly. In April, researchers found that a 40-year-old woman in Los Angeles with headaches, seizures, and hallucinations had RNA from the coronavirus in her cerebrospinal fluid.
One study recently found an explanation for how that may have occurred: The virus can directly enter and damage cells in the brain’s choroid plexus, which has cells with ACE2 receptors. “This can lead to leakage across this important barrier, that normally prevents entry of pathogens into the cerebrospinal fluid and the brain,” says study co-author Madeline Lancaster, a biologist and the group leader at the MRC Laboratory of Molecular Biology in Cambridge, UK.
The brain is normally protected from your blood, so it’s a big problem to have that barrier penetrated. During viral infections, many immune cells are activated and circulating through the body. Lancaster explains that even if the virus itself doesn’t get past the barrier, having “those inflammatory cytokines leak into the brain, where they really do not belong, can have serious repercussions.” One example is encephalitis, or inflammation of the brain itself, as found in this study of 12 Covid-19 patients in the UK.
Lancaster says viruses may penetrate the blood-brain barrier more often than previously thought. “The Covid crisis has shined a light on overlooked post-viral chronic fatigue syndrome (CFS),” she says. “There’s a lot of indication that inflammation of the brain can lead to those symptoms. There’s a huge overlap between those conditions and long Covid.”
But though post-viral symptoms may linger for months or even years, it can be hard for doctors to find clues in neurological tests. While encephalitis can be seen on MRIs, damage to the cerebrospinal fluid might not be visible. (Doctors can, however, look for elevated biomarkers like cytokines.) “Unfortunately, that’s one of the reasons a lot of patients with CFS have been told it’s all in their heads. We’ve let those patients down,” says Lancaster.
Neuro-inflammation can cause emotional and behavioral changes. Sammie, who asked that her last name not be used to protect her privacy, says she and her daughter were both infected in the UK with Covid-19 in March. Since then, her 15-year-old daughter has had headaches, dysautonomia, fatigue, and extreme anxiety and emotional outbursts. “She’s not a crier. She’s normally very stoic,” Sammie says, but over the last few months, “she’s had irrational outbursts, just sobbing her heart out.”
One study of 62,354 patients recently published in The Lancet Psychiatry journal found that one in five were diagnosed with a mental health disorder within three months of testing positive for the coronavirus. “But what’s the chicken and what’s the egg?” Lancaster asks. “It could be that there are people with leakier brains to start with, who when they get Covid-19 are more likely to have viral entry into their brain.”
Neuro-inflammation might also help explain some of the weirder long-Covid symptoms reported by parents of children who have had Covid-19, like something called Alice in Wonderland syndrome, an alteration of visual perception where objects or body part sizes are perceived incorrectly. Simpson says her son’s vision regularly goes blurry, and he describes people’s heads “going small.”
Gretchen Drown of Portland, Maine, also says that her 15-year old son, who got Covid-19 in March, describes “things looking weird,” and that during these episodes, his pupils get strangely dilated. Drown’s son also now has headaches and extreme fatigue, which worsen after he overexerts himself, making it hard to keep up with school.
Damaging the blood-brain barrier also hurts its ability to make cerebrospinal fluid, which is important for providing nutrients to the brain and removing its normal waste. Lancaster calls the cerebrospinal fluid the plumbing system of the brain. “Imagine your house with all your toilets clogged — a similar thing can happen in the brain,” she says.
Much of this fluid cycling normally occurs during sleep, so Lancaster suggests that Alice in Wonderland syndrome — and possibly other common neurological symptoms in long Covid, like extreme fatigue and insomnia — might be related to the virus compromising the body’s ability to generate and manage this fluid.
Children and long Covid
As the pandemic began, it appeared most children had mild cases of Covid-19. But while clinicians have not been tracking long Covid in children, it’s clear from the many parents Vox interviewed that children of any age can and do experience persistent symptoms that can completely alter their ability to function.
That no one seems to be paying attention to pediatric long-Covid cases is a source of extreme frustration. Multiple parents reported that during their efforts to get their children care, medical providers accused them of Munchausen syndrome, a psychological disorder where someone pretends to be ill.
Sammie says when a nurse suggested it to her, “I literally think if I hadn’t had a mask on, my jaw would have fallen off. I felt so broken — it makes me feel emotional talking about it now.” Since then, she’s complained to the clinic and actually gotten a letter of apology. But her experience demonstrates the hurdles parents face in getting their children the care they need. “I think there are a lot more children who are ill, and who no one is connecting the dots for,” Sammie says.
While it’s hard to quantify something no one is tracking, the American Academy of Pediatrics suggests about 11 percent of US Covid-19 cases are children, with over 1,460,905 children contracting the virus as of December 3. It’s easier to count more acute Covid-19 consequences, like MIS-C: In one study of kids under 18 with MIS-C, 14.8 percent exhibited new neurological symptoms like headaches, muscle weakness, and reduced reflexes. The youngest child with persistent symptoms Vox found was 18 months; the oldest was 15.
While some of the symptoms parents have reported in children are similar to adult long-Covid cases — headaches, extreme fatigue, difficulty concentrating or forming new memories, anxiety, depression, tachycardia, dysautonomia, lingering or recurrent fevers — others differ. Some parents in the long-Covid kids online group Sammie formed, for example, have been reporting frequent nosebleeds.
Some of the parents, like Simpson, are themselves suffering from long Covid. “In many families who have kids with long Covid, there’s a mother or father who has it as well. People should be tripping over themselves to research if this is genetic,” she says.
But in the meantime, for parents like Sammie, Simpson, Meredith, and Drown, there are few resources to help their children recover. Though it hasn’t been easy, Sammie hasn’t given up trying to get her daughter into more specialized care. “If I don’t advocate for my child, who the hell is going to do it?” she asks.
Parents worry about how their children’s lives might be impacted by the long-term effects of this disease. For adult patients, too, the repercussions are potentially huge.
One doctor, whose family asked that her name be withheld for privacy reasons, first got sick this spring. She eventually despaired of finding treatment for her long-Covid symptoms. She recently drove to New York — because she wanted to be near the best researchers she knew of — before ending her life. She donated her body to science.
For those who survive, like Brown, the questions are pervasive. “How will this affect me when I want to have a baby?” Brown asks. “What is next? We have no idea. No one can tell me anything specific.” She’s frustrated that friends her age still assume that if they get infected, they’ll recover.
“You might be okay, but you might not,” Brown says. She says she’s angry about how the pandemic has been measured in deaths rather than in lives disrupted. “The disparities are shocking. And more will be lost if we don’t make adjustments.”
Lois Parshley is a freelance investigative journalist. Follow her Covid-19 reporting on Twitter @loisparshley.


vox--2020-12-15--MacKenzie Scott, the Amazon billionaire, is giving away $1 billion a month to charity

One of the wealthiest people in the world , MacKenzie Scott , has spent the end of 2020 giving away about $ 1 billion a month , a staggering amount that sets a high mark for tech billionaires in terms of speed .
Scott , the ex-wife of Amazon founder Jeff Bezos , disclosed on Tuesday that she had donated $ 4 billion over the past four months to just under 400 nonprofit groups .
Over the past year , Scott has emerged as one of the most publicly generous philanthropists , parting with $ 6 billion and raising her @ @ @ @ @ @ @ , the world ’ s richest person .
Scott shared earlier this summer that she had changed her surname and already donated $ 1.7 billion of her fortune — donations that had already made her one of the world ’ s billionaires who is giving away her money the fastest , something that even well-intentioned billionaires struggle to do .
Many of the tech industry ’ s richest , including those attempting to become major philanthropists , have seen their fortunes only grow more staggering in 2020 .
Scott explicitly pointed out the @ @ @ @ @ @ @ the rest of America as the pandemic ravages the country and particularly impacts its lowest-income citizens .
That kind of rhetoric is something billionaires are often loath to touch when publicizing their philanthropy .
“ This pandemic has been a wrecking ball in the lives of Americans already struggling .
Economic losses and health outcomes alike have been worse for women , for people of color , and for people living in poverty , ” she wrote in her Medium post .
“ Meanwhile , it has substantially increased the wealth of billionaires.
@ @ @ @ @ @ @ Emily Dickinson in her announcement on Tuesday , played a pivotal role in the early years of Amazon but kept a low profile prior to her divorce from Bezos in 2019 .
Scott was awarded $ 38 billion in that split , a war chest that has grown to over $ 60 billion as Amazon stock has skyrocketed in the two years since .
As that happened , Scott has gingerly stepped more and more into the public eye .
Her donations have made her an unwilling and even unlikely spokesperson for billionaires @ @ @ @ @ @ @ rather than stockpiling their wealth in private foundations or family offices or in bequests to their children .
Just months after her divorce , Scott signed on to the Giving Pledge — the commitment to give away at least half of one ’ s money — which she and her then-notoriously parsimonious husband had declined to do when married and which he still hasn ’ t done himself .
Scott pulled back the curtain on Tuesday on her giving strategy .
Recode has previously reported that she is at least partly using a @ @ @ @ @ @ @ provides little transparency — and working with the consulting firm Bridgespan and its co-founder , Tom Tierney , to advise her giving .
Scott added that her team considered donations to about 6,500 organizations before culling those down to 384 groups .
After that , she said , they “ get out of their way.
” “ Not only are non-profits chronically underfunded , they are also chronically diverted from their work by fundraising , and by burdensome reporting requirements that donors often place on them , ” she wrote .
She did @ @ @ @ @ @ @ chose that “ the entire commitment would be paid upfront and left unrestricted in order to provide them with maximum flexibility.
” Scott didn ’ t disclose the amounts she gave to each nonprofit , but the list includes historically Black colleges and universities , food banks around the country ( a cause also prioritized by her ex-husband ) , and YMCAs .
Some of the colleges announced gifts as high as $ 50 million .

One of the wealthiest people in the world, MacKenzie Scott, has spent the end of 2020 giving away about $1 billion a month, a staggering amount that sets a high mark for tech billionaires in terms of speed.
Scott, the ex-wife of Amazon founder Jeff Bezos, disclosed on Tuesday that she had donated $4 billion over the past four months to just under 400 nonprofit groups. Over the past year, Scott has emerged as one of the most publicly generous philanthropists, parting with $6 billion and raising her profile after her record-setting divorce from Bezos, the world’s richest person.
Scott shared earlier this summer that she had changed her surname and already donated $1.7 billion of her fortune — donations that had already made her one of the world’s billionaires who is giving away her money the fastest, something that even well-intentioned billionaires struggle to do. Many of the tech industry’s richest, including those attempting to become major philanthropists, have seen their fortunes only grow more staggering in 2020.
Scott explicitly pointed out the dual realities in 2020 for billionaires and the rest of America as the pandemic ravages the country and particularly impacts its lowest-income citizens. That kind of rhetoric is something billionaires are often loath to touch when publicizing their philanthropy.
“This pandemic has been a wrecking ball in the lives of Americans already struggling. Economic losses and health outcomes alike have been worse for women, for people of color, and for people living in poverty,” she wrote in her Medium post. “Meanwhile, it has substantially increased the wealth of billionaires.”
Scott, a novelist who referenced Emily Dickinson in her announcement on Tuesday, played a pivotal role in the early years of Amazon but kept a low profile prior to her divorce from Bezos in 2019. Scott was awarded $38 billion in that split, a war chest that has grown to over $60 billion as Amazon stock has skyrocketed in the two years since.
As that happened, Scott has gingerly stepped more and more into the public eye. Her donations have made her an unwilling and even unlikely spokesperson for billionaires to donate their money with haste, rather than stockpiling their wealth in private foundations or family offices or in bequests to their children. Just months after her divorce, Scott signed on to the Giving Pledge — the commitment to give away at least half of one’s money — which she and her then-notoriously parsimonious husband had declined to do when married and which Bezos hasn’t done himself.
Scott pulled back the curtain on Tuesday on her giving strategy. Recode has previously reported that she is at least partly using a donor-advised fund — a controversial vehicle that provides little transparency — and working with the consulting firm Bridgespan and its co-founder, Tom Tierney, to advise her giving.
Scott added that her team considered donations to about 6,500 organizations before culling those down to 384 groups. After that, she said, they “get out of their way.”
“Not only are non-profits chronically underfunded, they are also chronically diverted from their work by fundraising, and by burdensome reporting requirements that donors often place on them,” she wrote. She did things differently, telling the nonprofits she chose that “the entire commitment would be paid upfront and left unrestricted in order to provide them with maximum flexibility.”
Scott didn’t disclose the amounts she gave to each nonprofit, but the list includes historically Black colleges and universities, food banks around the country (a cause also prioritized by her ex-husband), and YMCAs. Some of the colleges announced gifts as high as $50 million.


vox--2020-12-15--Trump’s rigged election rhetoric puts Georgia Republicans in a bind

President Donald Trump retweeted a tweet on Tuesday that claimed Georgia ’ s Gov .
Brian Kemp ( R ) and Secretary of State Brad Raffensperger ( R ) , both of whom have refused to help him overturn the results of the presidential election , “ will soon be going to jail.
” That ’ s ridiculous on its face .
But the deeper significance of that dangerously despotic statement shouldn ’ t be ignored .
There ’ s no evidence either man has done anything other than follow his legal duties to oversee a free and fair election @ @ @ @ @ @ @ by resisting the pressure campaign he ’ s waged to get them to overturn the results of the election in their state , which Biden won .
In this case , it is significant that the person who posted the original tweet was Lin Wood , an attorney who has teamed with the Trump campaign in its ill-fated lawsuits challenging Trump ’ s decisive losses in Georgia and other crucial swing states .
It marked the eighth time Trump has retweeted Wood since the election — a period in which Wood has been @ @ @ @ @ @ @ Georgia Republicans sitting out next month ’ s Senate runoffs , in which incumbent Republicans Sens .
David Perdue and Kelly Loeffler face Jon Ossoff and Raphael Warnock , over baseless concerns that elections in a Republican-run state were somehow rigged against the Republican president .
“ Why would you go back and vote in another rigged election ?
” Wood said during a rally last month in Atlanta , echoing Trump ’ s lies about how Georgia ’ s election was purportedly stolen from him .
Perdue and Loeffler have echoed these @ @ @ @ @ @ @ election , for instance , they released a joint statement saying Raffensperger “ failed to deliver honest and transparent elections .
He has failed the people of Georgia , and he should step down immediately.
” Notably , the statement didn ’ t contain a single specific allegation of fraud or irregularities .
But indulging Trump ’ s victimhood complex has a downside for Perdue , Loeffler , and Republicans who hope the party will keep control of the US Senate .
Encouraging people to go vote without at least paying lip service @ @ @ @ @ @ @ claims risks crossing the president , but encouraging them to sit out the runoffs risks handing control of the Senate to Democrats — and trying to thread the needle of encouraging them to vote while insisting elections are rigged against Republicans is obviously incoherent .
Perdue and Loeffler ’ s appearances on Monday ’ s edition of Fox & Friends illustrated the difficulty they ’ re in .
Challenged by host Ainsley Earhardt about how Georgia ’ s elections might be unrigged before January 5 , Perdue made a nonsensical case that he @ @ @ @ @ @ @ is corrupted .
“ Look , all these intransigencies happened in November , and we still won , ” Perdue said , alluding to his strong showing in the pre-runoff round of voting .
“ We shut them down then , we can do it again .
We have to get our vote out.
” Later , Loeffler didn ’ t have answers when hosts pressed her about why voters should believe the runoffs won ’ t be rigged when nothing has changed since the supposedly tainted process last month .
“ If @ @ @ @ @ @ @ will lose the country , ” Loeffler insisted , dodging the question .
“ We are the firewall to socialism.
” As Judd Legum put it in his Popular Information newsletter , Perdue and Loeffler ’ s position basically boils down to , “ This election is rigged .
Go vote.
” It makes no sense , but that ’ s the price they believe they must pay to not alienate Trump voters .
Trump is threatening to burn the house down unless Republicans do more to help him steal the election Trump @ @ @ @ @ @ @ this confusion by posting what basically amount to ransom notes on Twitter .
On Sunday , for instance , he demanded that Kemp call a special session of the legislature aimed at overturning his loss in Georgia to Biden — “ Otherwise , could be a bad day for two GREAT Senators on January 5th.
” Trump said much the same thing in a tweet posted on December 7 .
The implication of these tweets is that unless Georgia Republicans help him steal the election , Trump will purposely harm Loeffler ’ s @ @ @ @ @ @ @ , as well as his party ’ s chances of holding on to the Senate .
And since Georgia Republicans aren ’ t helping him , Trump is now not only retweeting prominent advocates of the idea that Republicans should sit out the runoffs , but he ’ s turned it up to 11 by amplifying calls for Kemp and Raffensperger to be locked up .
Control of the US Senate hangs in the balance Early voting has already started in Georgia , and if the first day — when more than 160,000 @ @ @ @ @ @ @ the Senate runoffs could be extremely high-turnout affairs .
Biden is doing what he can to help by traveling to Georgia on Tuesday to campaign with Ossoff and Warnock .
That trip comes days after Trump visited the state for a rally that was supposed to pump up Perdue and Loeffler , but ended up being a festival of grievances in which he whined about the Georgia election being rigged against him .
As Legum details , there ’ s some evidence that Wood ’ s and Trump ’ s rhetoric is demoralizing @ @ @ @ @ @ @ As I ’ ve previously detailed , rumblings about Trump fans staying home have been loud enough that Donald Trump Jr. last month felt compelled to weigh in with a tweet dismissing talk of withholding votes from Perdue and Loeffler as “ NONSENSE , ” adding , “ We need ALL of our people coming out to vote for Kelly & David.
” With polls indicating both races will be close , even small numbers of voters staying home could make all the difference in Georgia .
More broadly , as scenes from @ @ @ @ @ @ @ Washington , DC , illustrated , resentment that Trump fans feel over the Republican Party ’ s failure to overthrow the election results could end up creating a significant fissure on the right .
Instead of calling for unity , Trump is fanning the flames .
It ’ s bad for the GOP but good for his grievance-soaked brand — which seems poised going forward to increasingly be about how Democrats and weak-kneed Republicans like Kemp and Raffensperger looked the other way while the presidency was stolen from him .

President Donald Trump retweeted a tweet on Tuesday that claimed Georgia’s Gov. Brian Kemp (R) and Secretary of State Brad Raffensperger (R), both of whom have refused to help him overturn the results of the presidential election, “will soon be going to jail.”
That’s ridiculous on its face. But the deeper significance of that dangerously despotic statement shouldn’t be ignored.
Trump retweets martial law supporter Lin Wood's claim that Georgia's governor and Secretary of State "will soon be going to jail." pic.twitter.com/wb6q8rPteN — Christian Vanderbrouk (@UrbanAchievr) December 15, 2020
There’s no evidence either man has done anything other than follow his legal duties to oversee a free and fair election. But they’ve crossed Trump by resisting the pressure campaign he’s waged to get them to overturn the results of the election in their state, which Biden won.
In this case, it is significant that the person who posted the original tweet was Lin Wood, an attorney who has teamed with the Trump campaign in its ill-fated lawsuits challenging Trump’s decisive losses in Georgia and other crucial swing states.
It marked the eighth time Trump has retweeted Wood since the election — a period in which Wood has been one of the most prominent advocates of Georgia Republicans sitting out next month’s Senate runoffs, in which incumbent Republicans Sens. David Perdue and Kelly Loeffler face Jon Ossoff and Raphael Warnock, over baseless concerns that elections in a Republican-run state were somehow rigged against the Republican president.
“Why would you go back and vote in another rigged election?” Wood said during a rally last month in Atlanta, echoing Trump’s lies about how Georgia’s election was purportedly stolen from him.
Lin Wood: "I saw President @realDonaldTrump building up what I believed was going to be almost a historic landslide victory, and then all of a sudden every network, including @FoxNews...started lying to the American public." pic.twitter.com/H8UWqzZTki — Team Trump (Text TRUMP to 88022) (@TeamTrump) November 6, 2020
Perdue and Loeffler have echoed these sentiments. Shortly after November’s election, for instance, they released a joint statement saying Raffensperger “failed to deliver honest and transparent elections. He has failed the people of Georgia, and he should step down immediately.” Notably, the statement didn’t contain a single specific allegation of fraud or irregularities.
But indulging Trump’s victimhood complex has a downside for Perdue, Loeffler, and Republicans who hope the party will keep control of the US Senate. Encouraging people to go vote without at least paying lip service to Trump’s “rigged” claims risks crossing the president, but encouraging them to sit out the runoffs risks handing control of the Senate to Democrats — and trying to thread the needle of encouraging them to vote while insisting elections are rigged against Republicans is obviously incoherent.
Republicans are opting for incoherence
Perdue and Loeffler’s appearances on Monday’s edition of Fox & Friends illustrated the difficulty they’re in. Challenged by host Ainsley Earhardt about how Georgia’s elections might be unrigged before January 5, Perdue made a nonsensical case that he can still win even if the election is corrupted.
“Look, all these intransigencies happened in November, and we still won,” Perdue said, alluding to his strong showing in the pre-runoff round of voting. “We shut them down then, we can do it again. We have to get our vote out.”
David Perdue wants you to believe November's election in Georgia was rigged against Trump but "we still won." Totally incoherent. pic.twitter.com/m6DnExh9im — Aaron Rupar (@atrupar) December 14, 2020
Later, Loeffler didn’t have answers when hosts pressed her about why voters should believe the runoffs won’t be rigged when nothing has changed since the supposedly tainted process last month.
“If we don’t vote, we will lose the country,” Loeffler insisted, dodging the question. “We are the firewall to socialism.”
Kelly Loeffler can't really explain why the January Georgia runoffs won't be rigged even though Trump's loss last month allegedly was pic.twitter.com/wRe4q0Bv9b — Aaron Rupar (@atrupar) December 14, 2020
As Judd Legum put it in his Popular Information newsletter, Perdue and Loeffler’s position basically boils down to, “This election is rigged. Go vote.” It makes no sense, but that’s the price they believe they must pay to not alienate Trump voters.
Trump is threatening to burn the house down unless Republicans do more to help him steal the election
Trump, meanwhile, is only adding to this confusion by posting what basically amount to ransom notes on Twitter.
On Sunday, for instance, he demanded that Kemp call a special session of the legislature aimed at overturning his loss in Georgia to Biden — “Otherwise, could be a bad day for two GREAT Senators on January 5th.”
What a fool Governor @BrianKempGA of Georgia is. Could have been so easy, but now we have to do it the hard way. Demand this clown call a Special Session and open up signature verification, NOW. Otherwise, could be a bad day for two GREAT Senators on January 5th. — Donald J. Trump (@realDonaldTrump) December 14, 2020
Trump said much the same thing in a tweet posted on December 7.
RINOS @BrianKempGA, @GeoffDuncanGA, & Secretary of State Brad Raffensperger, will be solely responsible for the potential loss of our two GREAT Senators from Georgia, @sendavidperdue & @KLoeffler. Won’t call a Special Session or check for Signature Verification! People are ANGRY! — Donald J. Trump (@realDonaldTrump) December 8, 2020
The implication of these tweets is that unless Georgia Republicans help him steal the election, Trump will purposely harm Loeffler’s and Perdue’s chances of reelection, as well as his party’s chances of holding on to the Senate. And since Georgia Republicans aren’t helping him, Trump is now not only retweeting prominent advocates of the idea that Republicans should sit out the runoffs, but he’s turned it up to 11 by amplifying calls for Kemp and Raffensperger to be locked up.
Control of the US Senate hangs in the balance
Early voting has already started in Georgia, and if the first day — when more than 160,000 people voted — is any indication, the Senate runoffs could be extremely high-turnout affairs.
A record-shattering first day of early voting in the Georgia runoff: 168k vote in-person yesterday, up from 136k on day one of in-person early voting for the general election — Nate Cohn (@Nate_Cohn) December 15, 2020
Biden is doing what he can to help by traveling to Georgia on Tuesday to campaign with Ossoff and Warnock. That trip comes days after Trump visited the state for a rally that was supposed to pump up Perdue and Loeffler, but ended up being a festival of grievances in which he whined about the Georgia election being rigged against him.
Trump incoherently rants about the Georgia election being rigged against him while encouraging Georgia Republicans to go vote in the Senate runoffs next month pic.twitter.com/nJorjwE0yB — Aaron Rupar (@atrupar) December 6, 2020
As Legum details, there’s some evidence that Wood’s and Trump’s rhetoric is demoralizing some would-be Republican voters in Georgia:
“We really believe this election was crooked. I won’t [vote] next time unless they give us a clean election with paper ballots, IDs and fingerprints. I’m not doing Dominion machines,” Lauren Voyle, a Georgia voter who attended Trump’s December rally, said. Jason Shepherd, who chairs the Cobb County Republican Party in Georgia, says he “has been receiving a few emails a day from members claiming they won’t vote because they believe the process is corrupt.” Buzz Brockway, a former Republican state representative in Georgia, says there is a significant number of voters in the state who support Trump and not “the broader Republican Party.”
As I’ve previously detailed, rumblings about Trump fans staying home have been loud enough that Donald Trump Jr. last month felt compelled to weigh in with a tweet dismissing talk of withholding votes from Perdue and Loeffler as “NONSENSE,” adding, “We need ALL of our people coming out to vote for Kelly & David.”
With polls indicating both races will be close, even small numbers of voters staying home could make all the difference in Georgia. More broadly, as scenes from last weekend’s Trump marches in Washington, DC, illustrated, resentment that Trump fans feel over the Republican Party’s failure to overthrow the election results could end up creating a significant fissure on the right.
Nick Fuentes to Trump Supporters: “We are going to destroy the GOP” (for its failure to keep Trump in power)
MAGA crowd chants:
“Destroy the GOP! Destroy the GOP! destroy the GOP!”pic.twitter.com/SGAT9MWl13 — Johnattan F. Bilancieri (@BilancieriNews) December 12, 2020
Instead of calling for unity, Trump is fanning the flames. It’s bad for the GOP but good for his grievance-soaked brand — which seems poised going forward to increasingly be about how Democrats and weak-kneed Republicans like Kemp and Raffensperger looked the other way while the presidency was stolen from him.


vox--2020-12-15--Fauci: 85 percent of the US needs to get the Covid-19 vaccine for “true herd immunity”

Evidence-based explanations of the coronavirus crisis , from how it started to how it might end to how to protect yourself and others .
As the Covid-19 vaccination campaign gets underway , Dr. Anthony Fauci , the nation ’ s leading infectious disease scientist , told Vox ’ s Sean Rameswaram on Tuesday that he is hoping to get as much as 85 percent of Americans vaccinated against the virus .
“ If you really want true herd immunity , where you get a blanket of protection over the country ... you want about 75 to 85 percent of the @ @ @ @ @ @ @ , the longtime head of the National Institute for Allergy and Infectious Diseases , said in a live-recorded interview with Rameswaram , the host of Today , Explained .
“ I would say even closer to 85 percent.
” How many people need to get vaccinated to end the pandemic that has already killed more than 300,000 Americans and disrupted every facet of daily life has been the subject of some debate for months , as Vox ’ s Umair Irfan has covered .
The conventional wisdom has been that , at minimum @ @ @ @ @ @ @ to be vaccinated in order to start bringing case numbers down to a manageable level .
Fauci is aiming even higher .
“ We ’ ve got to get as many people as we possibly can , ” he said in the Vox interview .
Earlier this year , such a high threshold would have seemed outlandish .
In September , the Pew Research Center found that barely half of Americans ( 51 percent ) said they would definitely or probably get the Covid-19 vaccine .
That was down from 72 percent in @ @ @ @ @ @ @ rushed and politically influenced approval process spread .
But now , with Pfizer ’ s vaccine already in use and another from Moderna likely to gain approval from the Food and Drug Administration very soon , public attitudes are starting to improve , and Fauci ’ s goal does not appear so unrealistic .
Pew detected a rebound in vaccine acceptance at the beginning of December ; a new Ipsos poll this week found that 84 percent of Americans said they ’ d be willing to get a Covid-19 vaccine eventually ( although @ @ @ @ @ @ @ wait a bit ” rather than getting it as soon as it is available to them ) .
One thing that should help the Covid-19 vaccines stamp out spread , besides as many people getting their shots as possible , is that the Pfizer and Moderna vaccines appear to be extremely effective .
Both use a new technology called messenger RNA ( explained here by Vox ) , and both have been found to be more than 90 percent effective in preventing people from developing Covid-19 symptoms .
That ’ s “ almost @ @ @ @ @ @ @ Fauci told Vox .
He pointed out that the measles vaccine , with 98 percent effectiveness , is the best in the world and the new Covid-19 vaccines have nearly matched it .
“ We ’ re not too far away , ” he said , “ right in that ballpark of a really extraordinary vaccine.
” There are still unknowns about the Covid-19 vaccines .
How long will they provide protection ?
Will patients be diligent about getting both doses of the Pfizer and Moderna vaccines , so they get full protection @ @ @ @ @ @ @ from having symptoms , or do they actually prevent people from transmitting the virus ?
Not to mention the questions about producing enough doses and what will be done once other vaccines win federal approval .
But these are good problems to have .
A Covid-19 vaccine has been developed in record time , people seem receptive to getting vaccinated , and there are two highly effective vaccines so far .
Fauci said that even once 40 to 50 percent of Americans have gotten vaccinated , the US should “ start seeing an @ @ @ @ @ @ @ ” That is welcome news , with the country reporting more than 200,000 new cases and nearly 2,500 new deaths every day .
Vox ’ s live conversation with Fauci will be part of the Today , Explained upcoming podcast series “ You , Me , and Covid-19 , ” looking back on how the coronavirus has fundamentally reshaped our world .
Through reporting , listener reflections , and interviews , the team will examine how Covid-19 has changed our relationships with one another and the places we live , upended our livelihoods @ @ @ @ @ @ @ as “ normal.
” The first episode of the series drops on Monday , December 21 , and continues through that week .
Subscribe to Today , Explained wherever you listen to podcasts — including Apple Podcasts , Google Podcasts , and Spotify — so you don ’ t miss an episode .

As the Covid-19 vaccination campaign gets underway, Dr. Anthony Fauci, the nation’s leading infectious disease scientist, told Vox’s Sean Rameswaram on Tuesday that he is hoping to get as much as 85 percent of Americans vaccinated against the virus.
“If you really want true herd immunity, where you get a blanket of protection over the country ... you want about 75 to 85 percent of the country to get vaccinated,” Fauci, the longtime head of the National Institute for Allergy and Infectious Diseases, said in a live-recorded interview with Rameswaram, the host of Today, Explained. “I would say even closer to 85 percent.”
How many people need to get vaccinated to end the pandemic that has already killed more than 300,000 Americans and disrupted every facet of daily life has been the subject of some debate for months, as Vox’s Umair Irfan has covered. The conventional wisdom has been that, at minimum, 60 percent of people would need to be vaccinated in order to start bringing case numbers down to a manageable level.
Fauci is aiming even higher. “We’ve got to get as many people as we possibly can,” he said in the Vox interview.
Earlier this year, such a high threshold would have seemed outlandish. In September, the Pew Research Center found that barely half of Americans (51 percent) said they would definitely or probably get the Covid-19 vaccine. That was down from 72 percent in the spring, as fears over a rushed and politically influenced approval process spread.
But now, with Pfizer’s vaccine already in use and another from Moderna likely to gain approval from the Food and Drug Administration very soon, public attitudes are starting to improve, and Fauci’s goal does not appear so unrealistic. Pew detected a rebound in vaccine acceptance at the beginning of December; a new Ipsos poll this week found that 84 percent of Americans said they’d be willing to get a Covid-19 vaccine eventually (although 44 percent said they plan to “wait a bit” rather than getting it as soon as it is available to them).
One thing that should help the Covid-19 vaccines stamp out spread, besides as many people getting their shots as possible, is that the Pfizer and Moderna vaccines appear to be extremely effective. Both use a new technology called messenger RNA (explained here by Vox), and both have been found to be more than 90 percent effective in preventing people from developing Covid-19 symptoms.
That’s “almost as good as it gets,” Fauci told Vox. He pointed out that the measles vaccine, with 98 percent effectiveness, is the best in the world and the new Covid-19 vaccines have nearly matched it.
“We’re not too far away,” he said, “right in that ballpark of a really extraordinary vaccine.”
There are still unknowns about the Covid-19 vaccines. How long will they provide protection? Will patients be diligent about getting both doses of the Pfizer and Moderna vaccines, so they get full protection? Do the vaccines simply stop people from having symptoms, or do they actually prevent people from transmitting the virus? Not to mention the questions about producing enough doses and what will be done once other vaccines win federal approval.
But these are good problems to have. A Covid-19 vaccine has been developed in record time, people seem receptive to getting vaccinated, and there are two highly effective vaccines so far.
Fauci said that even once 40 to 50 percent of Americans have gotten vaccinated, the US should “start seeing an effect on the dynamic of the virus.” That is welcome news, with the country reporting more than 200,000 new cases and nearly 2,500 new deaths every day.
Vox’s live conversation with Fauci will be part of the Today, Explained upcoming podcast series “You, Me, and Covid-19,” looking back on how the coronavirus has fundamentally reshaped our world. Through reporting, listener reflections, and interviews, the team will examine how Covid-19 has changed our relationships with one another and the places we live, upended our livelihoods, and redefined what we thought of as “normal.”
The first episode of the series drops on Monday, December 21, and continues through that week. Subscribe to Today, Explained wherever you listen to podcasts — including Apple Podcasts, Google Podcasts, and Spotify — so you don’t miss an episode.


vox--2020-12-15--Senate Republicans are finally acknowledging that Joe Biden won the election

Six weeks .
Six weeks since the 2020 presidential election was called for Joe Biden , Republican senators are beginning to acknowledge that fact .
The Electoral College voted Monday , granting President-elect Biden 306 electoral votes to President Donald Trump ’ s 232 .
That development started a trickle that has turned into a flood — Sens .
Thom Tillis , Chuck Grassley , Shelley Moore Capito , Roy Blunt , John Cornyn , and Kevin Cramer are among those who have finally accepted what has been true for over a month : that Joe Biden won the November @ @ @ @ @ @ @ Senate Republicans reflects the finality of the Electoral College vote and the understanding that Trump ’ s legal challenges to the presidential vote tally have little chance of success .
Monday afternoon , Senate Majority Whip John Thune told reporters : “ At some point you have to face the music .
And I think once the Electoral College settles the issue today , it ’ s time for everybody to move on.
” As Andrew Prokop has written extensively for Vox , Trump ’ s attempt to overturn the results of the @ @ @ @ @ @ @ and the Electoral College vote marks an important turning point for Congress : Trump ’ s floundering effort to overturn the results of the election has had several focuses .
He ’ s ( unsuccessfully ) tried to prevent key states Biden won from certifying their results .
He ’ s ( unsuccessfully ) tried to get judges to step in and prevent certifications .
And he ’ s ( unsuccessfully ) tried to get Republican state legislators in those states to step in and appoint Trump-supporting electors .
...
So the Electoral @ @ @ @ @ @ @ formality .
But it will be an important one .
Because after it , statewide Republican officials and GOP state legislators — the politicians Trump has tried to lobby to overturn the results — will no longer play a role in the process .
The action , such as it is , will move on to Congress .
The most significant concession came Tuesday morning from Senate Majority Leader Mitch McConnell , who has until now refused to publicly recognize the results of the presidential election .
In a speech on the floor @ @ @ @ @ @ @ “ Six weeks ago , Americans voted in this year ’ s general election .
The legal and constitutional processes have continued to play out since then .
Yesterday , electors met in all 50 states , so as of this morning our country has officially a president-elect and a vice president-elect.
” In some ways , this flood of acquiescence can be read as an affirmation of democratic norms and processes — despite the Trump campaign and legal team ’ s best efforts , a court system chock-full of Republican appointees has @ @ @ @ @ @ @ to give victory to the sitting president , a theme Biden emphasized in a speech Monday night after the Electoral College vote .
But Trump pushed the country ’ s institutions to a breaking point .
His baseless accusations of voter fraud have managed to convince a broad swath of the country that the results were illegitimate and may have set a precedent to allow the loser to push every legal boundary in future closer elections .
The state of this moment can be summed up in one absurd fact : Russia ’ @ @ @ @ @ @ @ managed to congratulate Biden before the highest-ranking Senate Republican did .

Six weeks. Six weeks since the 2020 presidential election was called for Joe Biden, Republican senators are beginning to acknowledge that fact.
The Electoral College voted Monday, granting President-elect Biden 306 electoral votes to President Donald Trump’s 232. That development started a trickle that has turned into a flood — Sens. Thom Tillis, Chuck Grassley, Shelley Moore Capito, Roy Blunt, John Cornyn, and Kevin Cramer are among those who have finally accepted what has been true for over a month: that Joe Biden won the November 3 election. This growing chorus from Senate Republicans reflects the finality of the Electoral College vote and the understanding that Trump’s legal challenges to the presidential vote tally have little chance of success.
Monday afternoon, Senate Majority Whip John Thune told reporters: “At some point you have to face the music. And I think once the Electoral College settles the issue today, it’s time for everybody to move on.”
Senate Majority Whip John Thune said that Joe Biden is president-elect once he crosses 270 electoral votes and says efforts to challenge the results in Congress is “not going anywhere.” He said “it’s time for everybody to move on” after today. — Manu Raju (@mkraju) December 14, 2020
As Andrew Prokop has written extensively for Vox, Trump’s attempt to overturn the results of the election have failed time and again, and the Electoral College vote marks an important turning point for Congress:
Trump’s floundering effort to overturn the results of the election has had several focuses. He’s (unsuccessfully) tried to prevent key states Biden won from certifying their results. He’s (unsuccessfully) tried to get judges to step in and prevent certifications. And he’s (unsuccessfully) tried to get Republican state legislators in those states to step in and appoint Trump-supporting electors. ... So the Electoral College vote will also be mainly a formality. But it will be an important one. Because after it, statewide Republican officials and GOP state legislators — the politicians Trump has tried to lobby to overturn the results — will no longer play a role in the process. The action, such as it is, will move on to Congress.
The most significant concession came Tuesday morning from Senate Majority Leader Mitch McConnell, who has until now refused to publicly recognize the results of the presidential election. In a speech on the floor of the Senate, he announced: “Six weeks ago, Americans voted in this year’s general election. The legal and constitutional processes have continued to play out since then. Yesterday, electors met in all 50 states, so as of this morning our country has officially a president-elect and a vice president-elect.”
"Our country has officially a President-elect and a Vice President-elect ... the Electoral College has spoken" -- here's Mitch McConnell on the Senate floor congratulating Joe Biden and Kamala Harris on their victory over Donald Trump pic.twitter.com/LiBP1ULLWV — Aaron Rupar (@atrupar) December 15, 2020
In some ways, this flood of acquiescence can be read as an affirmation of democratic norms and processes — despite the Trump campaign and legal team’s best efforts, a court system chock-full of Republican appointees has refused to give credence to spurious attempts to give victory to the sitting president, a theme Biden emphasized in a speech Monday night after the Electoral College vote. But Trump pushed the country’s institutions to a breaking point. His baseless accusations of voter fraud have managed to convince a broad swath of the country that the results were illegitimate and may have set a precedent to allow the loser to push every legal boundary in future closer elections.
The state of this moment can be summed up in one absurd fact: Russia’s authoritarian president, Vladimir Putin, managed to congratulate Biden before the highest-ranking Senate Republican did.