Another Covid-19 wave is here. So far, it looks relatively mild. But even “mild” waves bring disruption—missed work, missed school, interrupted vacations—and risk of severe illness, especially for people who aren’t up to date on vaccines.

And then there’s long Covid.

Five years after it first appeared, hundreds of thousands of Americans are still living with its disabling effects. Progress in research has been slow and frustrating at times, but it has moved forward—study by study, patient by patient. Here’s what the science has revealed in the past year.

Note: If you’re new here, we share a long Covid update once or twice a year. This post builds on our last roundup—if you’d like to catch up, you can read that one here.

Most people with long Covid haven’t fully recovered

While some people gradually get better over time, full recovery is not guaranteed, and for the vast majority of people, symptoms persist or even evolve. For example:

• In one U.S. study of more than 1,000 people with long Covid: about half reported symptoms that came and went, 26% saw gradual improvement, 19% had no change, and 8% worsened.

• U.K. data—some of the best available—suggest about 30% of people recover within a year. That still leaves the majority struggling.

• Only ~2% report complete resolution of symptoms in some studies.

This pattern isn’t unique to Covid. After the original SARS outbreak in 2003, many survivors were still disabled nearly 20 years later.

For patients, the toll is wide-ranging: from brain fog to being bedridden, from repeat hospitalizations to major financial strain. One study found long Covid patients were three times more likely to be hospitalized again compared to with those without it.

The risk has gone way down—but not to zero

Measuring long Covid has always been messy. Definitions vary, the virus keeps changing, and immunity levels shift. Still, the best current estimates suggest about 3–8% of people in the general population have long Covid today.

Encouragingly, the number of new cases is falling. Why? Mostly because vaccines and prior infections now protect many people from severe disease, which is strongly linked to long Covid risk.

• Vaccination contributed to an estimated 70% of the decline in one study.

• Each new variant has brought lower long Covid rates, likely due to rising immunity rather than changes in the virus itself.

• Reinfections carry a lower risk than first infections (around 6% vs. 15%).

But risk isn’t gone. A recent preprint found that reinfections still increase the likelihood of long Covid compared with never being reinfected. Put differently: reinfection raises relative risk by 35%, but the absolute increase is about 3 extra cases per 100 people.

Risk isn’t the same for everyone

Like Covid-19 itself, long Covid risk varies by group. Women, older adults, and people with underlying conditions remain more vulnerable.

This past year, studies added more detail:

• Preexisting asthma and COPD increase risk.

• Exposure to air pollution (fine particulate matter) raises risk, with supporting evidence from Spain, Saudi Arabia, and Sweden.

• Lower physical fitness is linked to higher risk.

• Certain professions—especially healthcare and dental workers—face elevated risk.

The takeaway: risk is uneven, shaped by both biology and environment.

Treatments: still slow, but not stalled

There are still no FDA-approved treatments for long Covid. Care today focuses on symptom relief, rehab, and trial-and-error management. What’s urgently needed are biomarkers—tests that could diagnose and track the disease—and therapies that target its root causes.

That said, several promising randomized clinical trials are underway:

• Repurposed anti-inflammatory drugs (already approved for arthritis and lung disease) are being tested across four continents.

• A monoclonal antibody, originally designed to prevent Covid infection, is being studied in a randomized, placebo trial as a potential long Covid treatment in Florida.

Research funding: a rocky year

Funding tells its own story. The Biden administration’s initial investment in 2021 went mostly to observational studies—helpful for understanding the problem but less so for finding treatments. To accelerate progress, Senator Bernie Sanders introduced the Moonshot Act in 2024, proposing $1 billion annually for long Covid research over the next decade. It has yet to move forward.

In late March, the Trump administration rescinded 45 grants to study long Covid, but thanks to quick news coverage and advocacy efforts, the money was restored. However, other funding cuts continue to impact long Covid research and support.

Still, there is bipartisan willpower. At a recent Senate hearing, Senator Bill Cassidy (physician, Republican in Louisiana) noted research support for long Covid was important, and RFK Jr agreed, saying: “I am 100% committed to finding treatments for long Covid,” and “I have a son who is really dramatically affected.”

How I’m thinking about long Covid

Long Covid is one of the reasons I still try to avoid getting Covid-19 infections. (That, and the fact that as a working mom, I don’t have the luxury of being knocked out for a week.)

But like many risks in life, long Covid risk isn’t something I can reduce to zero. I think of it the same way I think about driving a car: every trip carries a small but real chance of an accident. I still drive, but I do what I can to lower my risk—seatbelts, airbags, safe driving.

Right now, research suggests the risk of developing long Covid from a single infection is about 2–6%. To put that in perspective:

• Less likely than long Covid

  • Being struck by lightning in your lifetime: ~1 in 15,000

  • Dying in a plane crash: ~1 in 11 million per flight

  • Being seriously injured in a car accident: ~1 in 700

• Similar ballpark

  • Appendicitis: ~1 in 15

  • Needing reconstructive surgery after a dog bite: 1 in 40

• More likely than long Covid

  • Asthma diagnosis: ~1 in 10

  • Developing diabetes (cumulative): ~2 in 5

So long Covid isn’t a freak accident like a lightning strike. It’s in the same category as other common medical conditions—serious enough that I don’t want to ignore it, but not inevitable either.

Bottom line

Long Covid remains one of the most serious legacies of the pandemic. Risk has decreased over time, but millions still live with symptoms that disrupt their lives. Treatments are not yet here, but the research pipeline is moving, and scientific and political willpower seem to remain strong.

The best protection remains prevention: stay up to date on vaccines, reduce exposure during surges, and care for your overall health.

Love, YLE

A big thanks to Andrea Tamayo and Hannah Totte for all the research that went into this post.

Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE is a public health newsletter that reaches over 380,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:

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Death by a thousand cuts

In February 2025, I started tracking any Trump administration action that fell into one of five broad authoritarian domains:

• Undermining Democratic Institutions & Rule of Law; Dismantling federal government

• Dismantling Social Protections & Rights; Enrichment & Corruption

• Suppressing Dissent & Controlling Information

• Attacking Science, Environment, Health, Arts & Education

• Aggressive Foreign Policy & Global Destabilisation; Nationalism

I wrote my first substack post pulling together the actions just three weeks in, at 78 recorded actions. This week, exactly seven months into Trump’s second term, we’ve hit 1000 recorded authoritarian-like actions. The administration is speeding up – it took almost 3 months for the first 250 actions, but the last 250 have come in just one month.

It’s time to take stock of what has happened and shake off the numbness induced by the constant onslaught of activity. Increasingly, the story has shifted from awful things promised to awful things done. This is a longer post than normal – but it needs to be to capture what has happened. All actions can be explored on my website trumpactiontracker.info.

Targets of authoritarian regimes

As explained in Timothy Snyder’s book On Tyranny, populist authoritarianism involves escalating attacks on both ‘outsiders’, such as immigrants or other minorities and the ‘elite’. As part of the latter, the would-be autocrat attacks an independent legal system, an independent media, and scholarship and science. The Trump administration has faithfully followed the playbook on all these fronts, with democratic institutions and accountability in the US now severely weakened.

For the rest of this post, I first highlight key actions that have targeted the rule of law, the media, control of information, and science. I end by discussing the increasing nationalism and militarisation of the state. Please read to understand the enormity of what has happened to America in just seven months.

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Undermining the rule of law

Attacking lawyers

The US has a strong constitution. But the first step in asserting your constitutional rights is finding a lawyer to represent you in court. The Trump administration has deliberately targeted high profile law firms who have brought cases against the administration through executive orders, even some aimed at individual firms. It made it impossible for these firms to do their job by restricting government access. Law firms have largely capitulated, offering hundreds of millions of dollars to the administration in ‘pro bono’ work. More insidiously, law firms have also self-censored, scaling back other pro bono work for those who might sue the government, and avoiding litigation that would place them in conflict with Trump. Meanwhile individual lawyers who are considered ‘anti-Trump’ have been fired, investigated, sanctioned, or hauled in front of committees. The leaders of the FBI, the Pentagon, and top lawyers in the military (JAG) have been replaced with Trump loyalists.

Attacking judges

Once a case gets to court, power lies – in theory – with the presiding judge. But the Trump administration has waged an escalating campaign on judges who rule against the executive. This included verbally attacking individual judges’ family members, firing immigration judges, firing judges ruling against the executive, arresting a Wisconsin judge for ‘obstruction’, ignoring expert panels for judicial appointments, and suing an entire federal bench in Maryland. The legal profession is increasingly speaking out about the culture of fear and intimidation as the abuse against judges escalates.

Ignoring the law

Even if a judge rules against the administration, their judgements are often simply ignored. One study found that the Trump administration was ignoring a third of all judicial rulings against it. The Supreme Court, with its 6-3 tilt towards conservative judges, is largely ruling with the administration – setting itself against its lower benches. In June, the Supreme Court took the enormous step of limiting federal judges’ power to block Trump orders nationwide. Liberal Justice Sotomayer has sounded the alarm in her dissents, arguing that fundamental rights to due process are being ignored and that the Supreme Court is “rewarding lawlessness”.

The Media and control of information

The media

Trump started by revoking White House media contracts, restricting access to White House press briefings for respected news organisations such as the Reuters and Bloomberg, and investigating and threatening to defund public broadcasters. By August, Voice of America has been shut down, broadcasters PBS and NPR have been defunded, media companies have settled many spurious lawsuits brought by Trump, and the Washington Post is losing prize winning journalists by increasingly supporting the administration under Bezos’ ownership. After settling a lawsuit brought by Trump, Paramount (owner of the mainstream channel CBS) had its multi-billion dollar merger with Skydance approved. CBS now has a federal babysitter appointed to ensure it isn’t ‘anti-Trump’ while the anchor of its premier news show resigned citing loss of editorial independence. Fox News acts as the administration’s mouthpiece, and by May, 23 Fox News employees had joined the Trump administration. Meanwhile the White House has also launched a pro-Trump news site.

Control of information

The administration is proceeding to control the information space in other authoritarian ways. An early executive order prevented primary, junior and high schools from teaching any ‘Anti-American’ material. Book bans in several states are accelerating, with Florida leading the way adding hundreds of new books to the banned list this year, including “The Diary of Anne Frank”. Oklahoma is to teach students Trump’s false 2020 election claims and just last week set out a plan to vet new teachers from New York or California with an “America First” ideology test.

Museums and libraries, custodians of knowledge and history, have also been targeted. Federal institutions supporting museums and libraries have been defunded with consequent library closures feared across the country. In April, the US military were ordered to purge their library holdings of books related to diversity and inclusion. In May, Trump fired the librarian of Congress, the first woman and African American to hold the post

The world-renowned Smithsonian museums have been specifically attacked: an executive order authorised Vice President Vance to “remove improper ideology” from the museum and the White House has just started a comprehensive ‘review’ of the Smithsonian to assess “alignment with American ideals”. Some Smithsonian exhibitions have already been altered or withdrawn with accompanying accusations of censorship.

Official government reports have been changed to align with administration ideology. The Energy Secretary said a few weeks ago that the Trump administration is updating the previously published National Climate Assessments to ‘fix’ their assessments of climate change. The head of the Bureau for Labor Statistics was fired after Trump wasn’t happy with its report showing slowing employment growth. Instead, Trump found someone to present more favourable numbers and is now replacing the BLS head with an unqualified loyalist.

The spread of disinformation more broadly is ubiquitous in the Trump administration. The prime example is that it is the official position of the White House that Trump won the 2020 election. Just last week, Trump boasted that Putin agreed with him that the Democrats ‘stole’ the 2020 election. Meanwhile, new candidates for federal jobs are being asked who won the 2020 election as a test.

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Changing the course of science

America was the world’s foremost scientific superpower. No longer. The Trump administration has imposed deep budget cuts on scientific, environmental, and evidence-based institutions. There are literally too many cuts – and jobs lost – to fit into this post but I will highlight a few key ones below.

At the Centers for Disease Control (CDC), $200 million in program funds have been frozen, affecting initiatives on youth violence, diabetes, tobacco control, and gun-injury research. The latest budget for the National Institutes of Health NIH proposes huge reductions while over $2 billion has already been lost, largely affecting research into infectious diseases. All research is monitored for censored terms, whether DEI, misinformation, Covid or climate change. Health Secretary RFK Jr has undertaken an effective and comprehensive assault on the availability of vaccines, from sacking the independent expert vaccine panel, to sowing doubt over settled science on the safety of vaccines, to defunding hundreds of millions of dollars of new vaccine research.

Environmental oversight has been sharply curtailed. The Environment Protection Agency’s (EPA) budget is set to drop by 55%, from $9 billion to $4 billion, with state and community grants facing an 88% cut. Environmental regulations on clean air and clean water are being weakened or removed and clean energy programs cut. NOAA’s climate research programs have been entirely defunded and all of the hundreds of researchers working on the flagship US climate report have been dismissed. Even NASA has been affected, with thousands of staff leaving, at least a quarter of its budget gone. Its head recently pulled NASA out of all of its climate change research.

Attacking universities

The Trump administration has directly targeted the wallets of US universities, slashing grant funding and reducing funding for ‘overheads’ (a key part of academic research funding). Elite universities, such as Harvard and Columbia, had all federal funding (amounting to billions of dollars) withdrawn in an effort to force them to submit to state oversight.

Universities have also been targeted with federal investigations over DEI, foreign funding, and alleged anti-semitism. They have been threatened with facing higher taxes on their endowments, with losing their ability to recruit international students, with losing their patents, or even with losing their accreditation to award degrees. International academics and students have been targeted – particularly if they have protested against Israeli actions in Gaza, with thousands of student visas revoked and vetting for ‘Anti-American’ sentiment introduced for new visa applications.

As attacks have moved on to the public universities, such as UCLA, universities have started to capitulate, paying the administration hundreds of millions of dollars in return for having their federal funding reinstated. Even worse, they have ceded oversight into their student admissions to the federal government and agreed to end DEI programmes on campus. Even Harvard looks set to settle with the administration.

Weaponising the state to suppress dissent

Trump has increasingly used the state as his own personal weapon against individuals or organisations that he views as his enemies. Special prosecutors who had investigated Trump were fired, FBI officials who’d investigated the Jan 6^th insurrection were fired, heads of agencies producing reports casting the administration in a bad light were fired. The Department of Justice started a working group to ‘name and shame’ Trump critics who could not be charged with a crime, while opening investigations into lawyers, former officials, Democratic senators, congress people or attorneys general. CEOs, celebrities (such as Beyonce or Taylor Swift), the chair of the Federal Reserve, and prominent journalists are verbally attacked if they criticise the administration. Media outlets are sued or denied access to the press pool if they step out of line.

Nationalism & militarisation

Since Trump took office in January 2025, his administration and rhetoric has seen a significant escalation in both nationalism and militarisation of the state.

Immigration and Customs Enforcement (ICE) is becoming ever more powerful. Trump’s ‘Big Beautiful Bill’ adds $70 billion to the ICE budget, increasing its budget 6-fold, while ICE agents take people off the streets in unmarked cars, while wearing plain clothes, masks and providing no identification. The National Guard is supporting ICE operations, with embedded media coverage from regime-friendly news stations.

Military-style force is used against Americans protesting ICE detention raids. The Pentagon deployed Marines to Los Angeles to support ICE operations. The border with Mexico has been largely militarised escalating the military role in immigration enforcement and reducing immigrants’ access to due process. Other arms of the state are now working with ICE to share details of people they come into contact with, whether that’s local police, social security or the inland revenue service.

New detention centres are being built, including mega-facilities and tent cities. There is deliberate dehumanisation of immigrants, with Republicans posing in front of detainees in cages. Terrible conditions are reported at “Alligator Alcatraz” in Florida, even as detainees are held without charges or access to legal representation. Democratic lawmakers have been denied entry to facilities several times, despite having the legal right to enter.

Once in detention, immigrants’ rights have been greatly eroded. The Supreme Court allowed Trump’s plan to deport immigrants to third countries without regard to whether immigrants have any connection to that country or to whether that country is safe. ICE has declared millions of undocumented immigrants ineligible for bond hearings, and has detained or deported valid green card holders and citizens without due process. ICE sent hundreds of migrants to dehumanising prisons in El Salvador, where they say they were tortured for months.

The administration is openly praising populist nationalists abroad, from El Salvador, to Argentina, to the AFD in Germany, Marine Le Pen’s nationalists in France and Nigel Farage’s Reform in the UK.

Most recently, Trump sent the National Guard to Washington DC and claimed federal control over the city, citing a non-existent crime wave. Trump has expressed a wish to extend federal control over more Democrat-run cities in the future to ‘tackle crime’ – moving away from justifications based on illegal immigration. Homeland Security Secretary Noem said of LA that she would “liberate this city from the socialists and burdensome leadership”. Meanwhile, the Department of Homeland Security is increasingly using white supremacist language and imagery in its communications. Make no mistake, America is being militarised by a nationalist populist regime.

The loss of American freedom

This post has really just touched on some key moments. There are – literally – 1000 actions taken in just seven months of Trump’s second term. There are still 14 more months till the midterms and over three years to the next presidential election. All the signs are pointing to a president – and a willing Republican party and levers of state – further tightening control over the media, information, science, state apparatus and electoral processes. Too many powerful firms and institutions are staying silent.

I fear that people are still far too complacent because the very word “America” conjures up the celebrated ideal of “America the free”. But “America the free” are just words and they are rapidly losing all meaning. Instead America is sleepwalking into a populist authoritarian regime - for the sake of its democracy it needs to wake up.

Postscript 1

There have been so many actions that, for this post, I’ve not even touched on the rampant corruption, the attacks on civil rights & labour unions, the aggressive foreign policy, trade wars, the dismantling of foreign aid and global health, the changes to electoral procedures…

Postscript 2

Thank you again to my incredible volunteers helping to track actions and maintain and improve the website!

The restructuring of the panel that advises the Centers for Disease Control and Prevention on vaccination policy took another turn Thursday, with the apparent barring of some experts from medical and public health groups from subcommittees that do the bulk of the body’s work.

The move comes after health secretary Robert F. Kennedy Jr. fired all 17 members of the Advisory Committee on Immunization Practices in early June, replacing them with seven individuals with limited related expertise. Several of them have publicly expressed skepticism about vaccines. 

Sources told STAT that at least some members of the ACIP’s work groups received a notice informing them they could no longer serve on the subcommittees. These individuals were representatives of organizations that have “liaison” status on the ACIP — groups like the Infectious Diseases Society of America, the American Academy of Family Physicians, the American Nurses Association, and the Association of Immunization Managers.

Continue to STAT+ to read the full story…