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So even in the context of a post-vaccine world, does long Covid makes the coronavirus too dangerous to live with? Can the world really treat it like a flu-level illness if it’s causing debilitating long-term problems for many?

The truth is there’s still a lot about long Covid we simply don’t know. We don’t know what causes it, or why some people seem to develop long Covid symptoms while others don’t. We don’t know with much precision how often long Covid occurs. We don’t know how variants of the virus, including delta, have altered the risk. We don’t even know if all the cases believed to be long Covid are actually caused by the coronavirus.

Nor do we know much about breakthrough cases among vaccinated people leading to long Covid, though we know there have been some cases. The vaccines very likely help to prevent long Covid by reducing both the likelihood of infection and severity of illness, both of which are associated with long-term complications. “If you’re not getting infected with Covid, you’re not going to get long Covid,” Putrino said.

All of this uncertainty makes it difficult to make any kind of sweeping declarations about long Covid. But based on my conversations with experts, the best we can say goes something like this: Long Covid is relatively rare, especially among vaccinated people. It will likely become rarer over time, especially as more people get vaccinated and the population in general develops stronger immune defenses against the coronavirus.

“The hope is that over time as more variants emerge, as we keep getting more booster vaccinations, [and] as our body becomes more accustomed to producing antibodies to this virus type, we’re going to see cases of long Covid reducing — to the point where it’s not really a thing anymore,” Putrino said. But he cautioned, “This is conjecture. We don’t know for sure.”

It’s helpful, then, to view long Covid through two lenses: what the outlook is right now, in August 2021, and what it might look like in a few months or years. How worried you should be today if you’re vaccinated depends, like many things in the pandemic, on your own risk tolerance. But in the long term, there are some hopeful signs.

What long Covid looks like now

There are some things about long Covid we do know. It’s a real medical problem, although its symptoms, severity, and duration vary from person to person. These symptoms aren’t permanent in all cases — potentially not any of them — but they can last for a year or more. And some treatments, part of a nascent and growing field of medicine, can potentially cut down the symptoms’ duration.

Most cases of Covid-19 don’t lead to long Covid. The limited data so far suggests 10 to 25 percent of adults infected with Covid-19 might develop long Covid (although experts advise a lot of caution in interpreting those numbers since the data here isn’t of great quality).

While we don’t know what causes long Covid, there are some theories — all speculative for now. One possibility is that lingering reservoirs of the virus or fragments of it continue to wreak havoc in the body. Another is that long Covid is part of the body’s healing process after fighting off the coronavirus. Yet another is that, because the SARS-CoV-2 virus is novel to humans, it can lead to a long-lasting overreaction by the immune system.

A major unknown is if all the detected long Covid cases are even caused by the coronavirus, given that some of the people who present long-term symptoms test negative for Covid-19 and related antibodies. Experts don’t deny that the symptoms are real, but it’s also possible that psychosocial circumstances or other pathogens could be behind some cases.

Many viruses, like seasonal flu, can cause long-hauler symptoms. One study in Pathogens suggested some long Covid cases may be due to reactivations of the Epstein-Barr virus that causes mononucleosis. (When I was in high school, I lost months to fatigue due to recurring mono.) So some people showing up at the doctor’s office with long Covid could have “long flu,” mono, or another disease entirely. “It’s hard to say,” Putrino acknowledged.

Long Covid remains a unique threat right now for two reasons: There’s still a lot of coronavirus out there, as the country deals with a recent surge driven by the delta variant. And compared to pathogens like the flu, fewer people have immune defenses built up against the virus, likely boosting the chances of developing Covid-19 and then long Covid compared to the risk of suffering long-term complications from the flu.

The good news: These risks can be mitigated with vaccines.

The vaccines cut the chances of getting infected by the coronavirus in the first place. To the extent long Covid cases are caused by the virus, that means fewer cases of long Covid. The delta variant and waning efficacy have complicated this, increasing the risk someone is infected with the virus even after vaccination — potentially necessitating booster shots. But the vaccines still offer some protection against the risk of any infection.

The vaccines also offer protection against severe disease. This protection has so far held up against the delta variant and despite concerns about waning efficacy: Multiple studies have found the vaccines are still around 90 percent effective against hospitalization or worse, both during delta’s spread and months after the shots are administered. A recent study from the Centers for Disease Control and Prevention found unvaccinated people are 29 times as likely to be hospitalized with Covid-19 than fully vaccinated people.

That’s especially important because long Covid also seems much more likely to develop in people who had severe cases of Covid-19. A study analyzing private health care claims, by the nonprofit FAIR Health, found that hospitalized Covid-19 patients were almost twice as likely as patients who weren’t hospitalized but were symptomatic to develop “post-Covid conditions.” Patients without symptoms were even less likely to develop longer-term conditions than those with symptoms, although it did happen in some cases.

NurPhoto via Getty Images
A woman waits outside a vaccination hub in Terlizzi, Italy. Long Covid risks can be mitigated with vaccines.

So to the extent that the vaccines make you less likely to get sick in the first place, and much less likely to get severely ill if you do get sick, they reduce your chance of getting long Covid. If you do get sick, though, there’s a lot we don’t know.

Some breakthrough infections can lead to long Covid, as one New England Journal of Medicine study tracking Israeli health care workers found. But that study also found the overall prevalence was low: Among nearly 1,500 fully vaccinated health care workers who were exposed to the coronavirus or had related symptoms, just seven, of 39 breakthrough infections, reported persistent symptoms after more than six weeks.

Still, that’s one estimate from a small study looking at a somewhat narrow time period. “The problem is that we know very little about how frequent breakthrough infections lead to long Covid,” Akiko Iwasaki, an immunologist at the Yale School of Medicine, told me.

Perhaps the best that can be said is the vaccines likely help, probably significantly, but it’s unclear just how much. Given that, and the spread of the delta variant, some experts say it makes sense for those worried about long Covid to remain cautious and mitigate exposure even after getting the vaccine, at least for now.

What long Covid might look like in the future

Moving forward, there are some reasons to be hopeful about long Covid.

For one, the Covid-19 pandemic will end. Through vaccination, natural infection, or both, the population will continue to build immunity against the coronavirus. Over time, this buildup will turn into a bulwark against SARS-CoV-2 — one that may not stop the virus from spreading entirely (experts expect the virus will instead become endemic, meaning it will still circulate as illnesses like colds and the flu do), but will at least reduce the number of infections and especially cut down on the most severe outcomes, like hospitalization and death.

Those population-level defenses will mean fewer infections and less severe illness, both of which will translate to fewer cases of long Covid over time.

Putrino offered an optimistic, albeit speculative, possibility: If long Covid is caused by an overreaction from an undeveloped immune system to a novel coronavirus, then the steady buildup of immunity and continued exposure to the virus over time could help reduce the risk of long Covid. In that case, the remaining incidents of Covid-19 as the virus turns endemic may be less likely to lead to long Covid.

“We need to focus on being a little more patient,” Putrino argued. “A year and a half feels like a long time. But in terms of how long it takes for our bodies to change and adapt to things, it’s a very short amount of time.”

Christophe Archambault/AFP via Getty Images
A Covid-19 patient at the pneumology unit of a hospital in Paris, France.

We’ll also hopefully learn much more about long Covid going forward. That may help with prevention, such as techniques or treatments to stop Covid-19 from leading to long Covid. It could also help with the treatment of long Covid, potentially reducing its severity or duration. (This will require taking long Covid seriously — something medical and research communities haven’t done in the past with “long haulers” dealing with other diseases.)

Over time, a waning pandemic and the reduced risk of getting Covid-19 could help us live with the virus, including with the possibility of long Covid. Just like people have learned to live with the flu and the severe outcomes it can cause (including long-term health complications and tens of thousands of deaths a year in the US), so too will people learn to live with a Covid-19 that’s weakened by the vaccines and natural immunity.

Just as is true with the flu, different individuals have different risk tolerances. Some people may choose to go out less during periods in which cases rise, continue to wear masks, or seek out booster shots. Others may decide the low chances of complications after they get a vaccine, if they even decide to get the shot, are tolerable enough to continue living as normal, even when cases rise within their community. Many will fall in between.

“Some people will do everything possible to prevent their risk, and other people will not worry as much,” Céline Gounder, an epidemiologist at New York University, told me. “It’s going to depend on the person.”

So the solution to long Covid may look a lot like the other scary, uncertain things about the pandemic, from variants to breakthrough cases: There’s no perfect option, but the best we can do is get as many people vaccinated as possible to defang the coronavirus — and greatly reduce the risk of long Covid — even if it’s never truly eliminated.

America’s jobs situation is certainly improving, with 20 million people receiving some sort of unemployment compensation in February 2021 compared to around 12 million right now. And according to data from the Bureau of Labor Statistics, there were 10 million job openings across the country as of June.

Still, there are questions about what the impact of cutting off expanded benefits now will be. Expanded unemployment programs have helped people avert economic disaster over the past 18 months, and it’s not clear what damage might be ahead. The dangerous delta variant is spreading and hitting many parts of the country hard. Hopes that the fall would bring more of a return to normal are fading. Some schools have already started to pause in-person learning or switch to hybrid models, and some parents still prefer to keep their kids home instead of in the classroom or in child care centers out of safety concerns. Return-to-the-office plans for many businesses are still in flux. Come early September, the people still out of a job aren’t going to be able to snap their fingers and land back at work.

That’s certainly the case for Sean, whose hospitality job was unavoidably altered by the pandemic. He acknowledges this has happened to thousands of others as well. “It seems the line of work I was in, as well as thousands of other hospitality cooks, chefs, etc., has completely ceased to exist with the transition to work from home,” he says.

7.5 million people is a lot of people to cut off from unemployment insurance all at once

When the pandemic hit in early 2020, shutdowns meant millions of workers were laid off or furloughed seemingly overnight, and by no fault of their own. Since then, unemployment insurance has made a meaningful difference in helping those people maintain some sort of economic stability, along with other stimulus programs. But expanded unemployment insurance has also been controversial: Many Republicans, business groups, and even some Democrats have argued that it’s too much and is keeping people out of work. And as the economy has recovered, that argument has only gotten louder as some contingents hold that generous benefits are causing a labor shortage.

It is true that some workers are staying on the sidelines — in many parts of the country, it feels like there are “Help Wanted” signs everywhere, and business owners are complaining about not being able to find employees. But what’s not clear is exactly what is causing this; it’s likely a range of factors.

Peter Ganong, a public policy professor at the University of Chicago who has studied the potential disincentive effects of expanded unemployment insurance through the spring of 2021, said that more benefits are having somewhat of an impact, but not a big one. “Only a very small fraction of the number of jobs we need to get back to the pre-pandemic level or trend reflect the unemployment insurance disincentive effect,” he said.

new results on the effect of UI supplements on job-finding

2 designs x 2 policy changes yield consistent pattern: small, precisely estimated disincentive effects

Disincentive remains small even after job openings up pic.twitter.com/SsUHCHQddj

— Peter Ganong (@p_ganong) July 29, 2021

Among states that cut off expanded benefits early over the summer (26 in total, all but one Republican-led), the move doesn’t appear to have significantly contributed to job growth, though economists continue to debate what will happen going forward. New research released in August, first reported on by the New York Times, found that states ending benefits early didn’t meaningfully boost employment but did slash spending — a sign that it’s detrimental to workers and, potentially, the broader economy. The study found that for every eight workers who lost benefits, one found a new job. Meanwhile, it estimates that workers lost $278 a week in benefits on average but gained just $14 a week in earnings. Their spending fell by $145 a week. In the 19 states analyzed, that translates to a $2 billion drop in spending and a $270 million increase in earnings.

More people are likely to reenter the workforce over the weeks and months to come, as they have in previous months and weeks. But the transition won’t be guaranteed or easy. Some workers are struggling to find jobs that match their skills and aren’t positioned to take just any job, or they’re older, or they don’t have the credentials required for certain positions, or, for whatever reason, they’re just not getting a call back.

Sean, who has a degree in creative writing, has never been able to find a full-time position using that credential. Per California’s requirements, he has been applying for at least three jobs a week since July (even though he planned to go back to his prior employer until recently). He says he hasn’t gotten a single reply. “I have done a dozen or so skill assessments along with the applications, and I’m not hearing anything,” he says.

Workers really don’t know what the fall will bring

When President Joe Biden signed the American Rescue Plan in the spring, the White House and lawmakers rather arbitrarily anticipated that it would be appropriate for unemployment benefits to end on September 6. They didn’t anticipate some of the current challenges workers are facing, including the delta variant and an uncertain scenario for schools, that might render this a bad time to push the unemployed off a cliff.

There are myriad reasons people may not be able to return to work right now, or may be more hesitant to go back. Covid-19 cases and deaths are on the rise again. While the vaccines are available, many people are still nervous to get back out there.

Whether offices will reopen or businesses will close back down is uncertain. Some events are already being canceled, and offices are extending remote work, both of which have important implications for many jobs. Workers in the live events space expecting that work to come back might need to figure out if it’s time for them to change careers altogether instead of continuing to wait it out. Businesses in areas where there used to be a lot of office workers may not need to hire as many employees back soon, or ever.

Child care and elder care remain a challenge for many families. It’s not clear whether schools and day cares will go back to in-person learning and stay that way, meaning a parent may need to stay home. Families may also be hesitant about older parents staying in assisted living facilities and opt to move them home, another care burden.

“For parents, and especially mothers, the ability to go back to work just isn’t there right now. Schools at this point seem to be planning to open, but the minute we see things are bad and kids are getting sick, then things may change again,” said Julie Kashen, a senior fellow and director for women’s economic justice at the Century Foundation. “We don’t know what the fall is going to bring, but we do know it’s not going to bring a full recovery that suggests people don’t still need support.”

Once benefits are cut off, and if people aren’t able to find work, that can do significant harm to their finances and their lives. As the aforementioned research shows, it may also be detrimental to the economy, because people who don’t have money coming in also don’t have money to spend.

“If you’re saying, ‘I’m just going to shut off your benefits,’ but I still don’t have child care, and I still don’t have a way to ensure my child is attending their digital school, how is that going to force me into the labor market?” Rebecca Dixon, executive director of the National Employment Law Project (NELP), told Vox earlier this year. “It may force me into homelessness. It may force me to be hungry. There’s an enormous number of workers that are still behind on rent. This whole narrative is just completely wrong, and it’s incomplete.”

America needs to have a bigger conversation about unemployment insurance

“The anti-poverty response to the pandemic has been really dramatic, unlike anything we’ve ever done before. We’ve done a much better job of ensuring income risk from unemployment,” Ganong said. What that will mean down the road — especially as benefits are shut off — is up in the air. The Labor Department is upping investments in grants to help train some workers, which could help more people find something new. But workers have also found it difficult to decipher whether they need to switch jobs or not.

Apart from what happens in the immediate term, there is one bigger issue in play here: America’s unemployment insurance system needs to be reformed. It’s run as a federal-state program that leaves states with a lot of leeway as to how much assistance to provide workers, what parameters to put in place, and how easy or difficult to make accessing benefits. Many Americans saw firsthand when the pandemic hit just how hard the system is to navigate.

Congress has been guessing at how long expanded unemployment insurance will be needed from the outset of the Covid-19 outbreak. At the outset of the pandemic, President Donald Trump signed a bill putting in place $600 a week in extra federal unemployment benefits, which expired in July 2020. Then lawmakers added an extra $300 in benefits in December, which were extended under Biden. Now both the extra money and the expanded programs are supposed to wrap on Labor Day.

Given the current scenario, reasonable minds could question whether conditions are right to cut people off. Lawmakers could try to put in place conditions to better automate unemployment benefits so that it’s based not on political whims but on the actual health and economic situation on the ground. They could also strengthen minimums required of states so that an unemployed worker in Mississippi isn’t positioned much worse than someone in Massachusetts.

There have been some rumblings from progressives about the possibility of pushing for another extension of pandemic unemployment benefits, but many on the Hill believe that at this point, it’s really a nonstarter. “We don’t have the votes in the caucus for an extension,” one Democratic aide told Vox in an email.

Biden has urged Congress to take up unemployment insurance reforms as part of its upcoming budget reconciliation process, an agenda that he wants to include fraud prevention, equitable access, and adequate support. Those types of measures would make a real difference in the future, but they won’t help workers like Sean, who are being harmed by the cutoff right now. “Safety is really important in all of this, and I’m not mad at the company at all, no harsh feelings whatsoever,” Sean says. “I’m just frustrated by the situation as a whole.”

A satellite image of Hurricane Ida, on August 29, 2021. | Courtesy of NOAA/STAR

Hurricane Ida’s Category 4 designation is based on wind speeds and potential property damage.

Hurricane Ida has begun pummeling the Gulf Coast, making landfall as a Category 4 storm on Sunday near Port Fourchon, Louisiana. The storm has already tied for the strongest recorded landfall in Louisiana, with winds at 150 miles per hour. Hurricane Laura in 2020 also had 150-mile-per-hour winds, as did an 1856 hurricane, according to the Weather Channel.

Hurricane Ida’s rapid development made preparation more challenging, as the Gulf Coast already grapples with Covid-19 hospitalizations. New Orleans Mayor LaToya Cantrell issued an evacuation order for only part of the city, because there simply wasn’t enough time to evacuate all of New Orleans.

“Time is not on our side,” Cantrell said in a press conference Saturday, noting that the hurricane was, “rapidly growing” and “intensifying.”

Hurricanes’ destructive potential is often correlated with a measurement system called the Saffir-Simpson Hurricane Wind Scale. It’s a five-tier scale ranking hurricanes from least destructive (Category 1) to most destructive (Category 5), with categories 3, 4, and 5 ranking as major hurricanes with extremely high wind speeds that have the potential to uproot trees, knock out electricity, tear the roofs off homes, or destroy them completely.

How hurricanes change so fast

Most hurricanes that impact the US start out as thunderstorms off the coast of Africa, according to the University Corporation for Atmospheric Research (UCAR) Center for Science Education. Occasionally, several thunderstorms form at once and encounter a point of low atmospheric pressure called a tropical depression. The clouds rotate around the tropical depression — creating the beginnings of a hurricane’s characteristic swirl of clouds — and pick up speed as they draw energy from the warm water below.

If this mass of swirling clouds reaches a windspeed of 39 miles per hour or above, it’s classified as a tropical storm, the precursor to a hurricane. If the storm keeps picking up speed and reaches wind speeds of at least 75 miles per hour, then it’s officially a hurricane.

The formation of these storms depends on humid air, warm waters, and a tropical depression. These enable the air and water, as they interact, to release more moisture, creating more clouds. Air rotates the mass of clouds as it rises; in the Northern Hemisphere, air pulled into the center, or eye of a hurricane, bends to the right due to the earth’s rotation. In the Southern Hemisphere, that air bends to the left in the same weather phenomenon, called the Coriolis effect. The Coriolis effect doesn’t exist within 300 miles of the equator, so hurricanes (or tropical cyclones or typhoons, depending on the part of the world they hit) can’t form in that region.

Thunderstorms intensify into tropical storms and hurricanes when the atmosphere and water are warm enough to generate increased energy to keep the storms moving. Cooler water weakens a hurricane; they also weaken when they hit land, but by that point, the damage has already started.

What is happening with Ida

Hurricane Ida reached Category 3 status early on Sunday morning as it moved toward the Louisiana coast, the New York Times reported. A Category 3 hurricane can cause “devastating” damage, according to the National Hurricane Center. With winds ranging from 111 to 129 miles per hour, Category 3 hurricanes can cause major damage, even on sturdy, well-built homes. These hurricanes can also damage trees and knock out electricity.

Hurricane Irma, a Category 3 storm that hit Florida in 2017, caused “widespread devastation,” even though it had weakened from a Category 4 when it hit land over the Florida Keys.

According to a report from the National Hurricane Center, Irma “was one of the strongest and costliest hurricanes on record in the Atlantic basin,” directly killing 47 people in Florida and the Caribbean, and causing a further 82 indirect deaths due to “a combination of falls during preparations for Irma’s approach, vehicle accidents, carbon monoxide poisoning from generators, chainsaw accidents, and electrocutions,” as well 14 deaths due to overheating from lack of air conditioning at a nursing home. Irma caused hundreds of millions of dollars in damage, as well as a record 5 feet of flooding in Jacksonville.

The National Hurricane Service upgraded Hurricane Ida to Category 4 Sunday, just an hour after it was designated a Category 3 hurricane.

How Ida compares to Katrina and other major hurricanes

As Hurricane Ida approached the Gulf Coast, politicians and headlines invoked comparisons to Hurricane Katrina, another storm that caused devastation in parts of Louisiana, Mississippi, and Alabama. Hurricane Katrina approached the Gulf Coast as a Category 4 hurricane and weakened to Category 3 as it made landfall.

Hurricane Rita, a Category 3 storm, hit less than a month later.

Katrina’s effects were widespread and long-term; the storm and its aftermath killed 1,833 people and caused $108 billion in damage.

Hurricane Katrina was also notable for the ways in which it exposed stark racial divides, both while it was active and in the US government’s response to the storm.

“Images of poor, mostly Black New Orleans residents stranded on rooftops and crowded amid fetid conditions in what was then the Louisiana Superdome” accompanied news stories, the Pew Research Center wrote in a 10-year retrospective.

In a national poll conducted a week after the hurricane, 66 percent of Black respondents said they believed “the government’s response to the situation would have been faster if most of the victims had been white,” according to Pew.

And while New Orleans is still predominantly a Black city, there are 100,000 fewer Black citizens than there were before Katrina, the AP reported in 2020.

Hurricane Harvey, another Category 4 storm, hit Texas and Louisiana in August 2017; in two days, it was upgraded from a tropical storm to a Category 4 hurricane. Hurricane Harvey slowed after it made landfall, causing torrents of rain to flood southeast Texas.

The rapidly intensifying nature of these storms is concerning, but scientists aren’t yet clear on whether it’s actually happening more often. In a piece in the Conversation about Hurricane Laura — another storm that rapidly progressed from a tropical storm to a Category 4 hurricane — Chris Slocum, a physical scientist at the NOAA and Cooperative Institute for Research in the Atmosphere at Colorado State University, wrote, “The Atlantic has seen several hurricanes rapidly intensify like this in recent years.” However, storms that behave this way “are fairly rare,” so, he writes, “there isn’t enough information yet to say if rapid intensification is happening more often.”

Still rarer are Category 5 hurricanes, but they do happen, and they render affected areas “uninhabitable for weeks or months,” according to the National Hurricane Center.

Hurricane Maria, the 2017 storm that demolished Caribbean islands including Puerto Rico, hit the island of Dominica as a Category 5 storm.

A National Hurricane Center Tropical Cyclone report sums up the devastation to Puerto Rico’s infrastructure:

“Maria knocked down 80 percent of Puerto Rico’s utility poles and all transmission lines, resulting in the loss of power to essentially all of the island’s 3.4 million residents. Practically all cell phone service was lost and municipal water supplies were knocked out. At … the end of 2017, nearly half of Puerto Rico’s residents were still without power, and by the end of January 2018, electricity had been restored to about 65 percent of the island.”

A study from Harvard University’s T.H. Chan School of Public Health estimated the death toll from Maria at 4,645, although the numbers could be higher.

Hurricane Ida will test the readiness of New Orleans’s infrastructure to handle storms of this magnitude after Hurricane Katrina. Those who have fled the area now don’t know when they’ll be able to go back home, or if home will even exist once the storm subsides. People who must remain — for one reason or another — will be dealing with power outages, water and supply shortages, flooding, and devastation yet to be seen.

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