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Prior coverage of news, publications and reports

Hu & Dill found that physician work hours significantly decreased during the pandemic despite increased percentages in lay-offs among physicians. The authors suggest that these changes may reflect health care utilization decreases driven by the pandemic. Changes in Physician Work Hours and Patterns During the COVID-19 Pandemic (JAMA Open Netw, June 23, 2021)

Diesel and colleagues provide an update on the U.S. COVID-19 vaccination program. Only 57% of adults received at least one dose by late May. Among the highest vaccinated group are adults aged 65+, while adults under 30 remains low. Equitable access to vaccinations is still needed and imperative for efforts to increase vaccinations among younger adults. COVID-19 Vaccination Coverage Among Adults — United States, December 14, 2020–May 22, 2021 (MMWR, June 21, 2021)

Mark Czeisler et al. present data on the mental health of caregivers and parents during the COVID-19 pandemic. Both parents and unpaid caregivers of adults had significantly worse mental health symptoms than adults not in those roles. Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic—United States, December 2020 and February–March 2021 (MMWR, June 18,2021)

Asch and colleagues discuss hospital factors impacting mortality rates in black and white Medicare beneficiaries hospitalized with COVID-19. The study found that increased mortality in Black patients was associated with hospitals where Black patients disproportionately received care. Patient and Hospital Factors Associated With Differences in Mortality Rates Among Black and White US Medicare Beneficiaries Hospitalized With COVID-19 Infection (JAMA Netw Open, June 17, 2021)

Park, Kim and Briesacher found that older adults entering LTC facilities in highly socially isolated areas had a 17% higher 30-day mortality rate compared to those with low levels of social isolation. Association of Social Isolation of Long-term Care Facilities in the United States with 30-Day Mortality (JAMA Netw Open, June 16, 2021)

Christie et al. discuss decreases in COVID-19 cases, ED visits, hospital admissions, and deaths in older adults after COVID-19 vaccine introduction. By May 1st, 2021, 82% of adults 65 and older had received at least one COVID vaccine. The decreasing morbidity and mortality in older adults demonstrates the potential impact of increasing population-level vaccination coverage. Decreases in COVID-19 Cases, Emergency Department Visits, Hospital Admissions, and Deaths Among Older Adults Following the Introduction of COVID-19 Vaccine — United States, September 6, 2020–May 1, 2021 (MMWR, June 11, 2021)

Kimani et al. examine associations of race and ethnicity and food insecurity with COVID-19 infection rates. The study found an association between race/ethnicity and infection rates with an interaction with food insecurity in counties with large Black or American Indian populations, but not in counties with large Hispanic populations. These findings suggest that public policy should consider county-level food insecurity to better understand the social dynamics of the COVID-19. Associations of Race/Ethnicity and Food Insecurity With COVID-19 Infection Rates Across US Counties (JAMA Netw Open, June 8, 2021)

Yu et al. comment on changes in non-COVID-19 emergency department (ED) visits by acuity and insurance status during the COVID-19 pandemic. In this St. Louis sample, there was no significant difference in utilization by acuity level. These findings can help inform interventions to ensure that people requiring timely ED care continue to seek it and improve access to lower-risk alternative settings of care where appropriate. Changes In Non-COVID-19 Emergency Department Visits By Acuity And Insurance Status During The COVID-19 Pandemic (Health Affairs, June 7, 2021)

Tarazi et al. examine COVID-19 related deaths and excess deaths among Medicare fee-for-service beneficiaries. In this study, the authors found that mortality varied by comorbid conditions, similar to the findings of other recent studies. COVID-19-Related Deaths And Excess Deaths Among Medicare Fee-For-Service Beneficiaries (Health Affairs, June 7, 2021)

Solomon et al. found that no significant declines in AMI hospitalizations or stroke alerts occurred from October 2020 to January 2021. These findings are a change from prior COVID-19 surges, which significantly impacted hospital presentation for acute cardiovascular causes. Changes in Patterns of Hospital Visits for Acute Myocardial Infarction or Ischemic Stroke During COVID-19 Surges (JAMA, June 2, 2021)

Barry et al. comment on the increasing disparities in county-level vaccination based on social vulnerability. Public health messaging tailored to local populations and increasing vaccination access could help increase vaccination coverage in counties with high social vulnerability. Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity — United States, December 14, 2020–May 1, 2021 (MMWR, May 28, 2021)

Sun et al. discuss a decrease in EMS calls and increased hospital transportation refusal and out-of-hospital cardiac arrest incidence during the initial COVID-19 wave. Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care (Health Affairs, May 26, 2021)

Murthy et al. comment on urban and rural COVID-19 vaccination disparities in the US from December 2020 to April 2021. Vaccination coverage was lower in rural counties than in urban counties, contributing to slower progress of bringing an end to the pandemic. Continued multi-partner collaborations are needed to address vaccine hesitancy and equitable access in rural areas. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021 (MMWR, May 21, 2021)

Whiteman et al. comment on the first three and half months of vaccination efforts among older adults. This study reports lower vaccination initiation rates in counties with higher percentages of older adults with social vulnerabilities. Demographic and Social Factors Associated with COVID-19 Vaccination Initiation Among Adults Aged ≥65 years—Unites States, December 14, 2020-April 10, 2021 (MMWR, May 14, 2021)

Docherty et al. discuss finding of reduction of in-hospital mortality observed in all age groups during the first wave of the UK COVID pandemic. Changes in case mix and illness severity, as well as differences in respiratory support and critical care use, partly accounted for this reduction of in-hospital mortality. Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using WHO Clinical Characterisation Protocol UK (The Lancet, May 14, 2021)

Misera-Hebert et al. discuss the health system utilization impact of a home-monitoring program for patients with positive SARS-CoV-2 infection. While the program was associated with lower odds of hospitalization, it did not find significantly decreased ED utilization up to 90 days following diagnosis. COVID-19 Home Monitoring After Diagnosis and Health Care Utilization in an Integrated Health System (JAMA Health Forum, May 6, 2021)

Angel et al. report on the association between Pfizer vaccination and incidence of COVID-19 infections among health care workers. Vaccination was associated with a significantly lower incidence of symptomatic and asymptomatic infection. Association Between Vaccination With BNT162b2 and Incidence of Symptomatic and Asymptomatic SARS-CoV-2 Infections Among Health Care Workers (JAMA, May 6, 2021)

Werner & Coe discuss nursing home staffing levels during the pandemic in Health Affairs. Although the number of staff hours in nursing homes did not decline, the perception of shortages has been driven by increased stresses and demands on staff time due to the pandemic, which are harder to quantify. Nursing Home Staffing Levels Did Not Change Significantly During COVID-19 (Health Affairs, May 3, 2021)

Sung Park’s study found that caregivers demonstrated worse mental health and fatigue symptoms than non-caregivers during the pandemic. Caregivers’ Mental Health and Somatic Symptoms During COVID-19 (The Journals of Gerontology: Series B, April 2021)

Chen et al. found an estimated deficit of 9.4 million (breast, colorectal, or prostate cancer) screenings associated with the COVID-19 pandemic meaning that public health efforts are needed to make up for the substantial deficit in preventative screenings. Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic (JAMA Oncol, April 29, 2021)

Tenforde et al. report on a multi-state network of U.S. hospitals for the first quarter of 2021. COVID-19 vaccinations significantly reduced the risk for COVID-19 associated hospitalization. Receipt of Pfizer or Moderna was 94% effective among fully vaccinated adults and 64% effective among partially vaccinated adults. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years — United States, January–March 2021 (MMWR, April 28, 2021)

Bandyopadhyay et al. present the findings of a systematic review on infection and mortality of healthcare workers worldwide from COVID-19. This review found that while infections are primarily recorded in women, deaths were mainly reported in men. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review (BMJ Global Health, April 26, 2021)

Hernandez-Romieu et al. report on health care utilization and clinical characteristics of non-hospitalized adults following COVID-19 diagnosis. In this sample, 69% had one or more outpatient visits 28-180 days following diagnosis. Health Care Utilization and Clinical Characteristics of Nonhospitalized Adults in an Integrated Health Care System 28–180 Days After COVID-19 Diagnosis — Georgia, May 2020–March 2021 (MMWR, April 23, 2021)

Gracner et al. comment on the significant association between NH residents’ infection-related hospitalizations and decreased cognitive function. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents (JAMA Netw Open, April 23, 2021)

McDermott & Newman present proposed remote adaptations of randomized trials for consideration. Remote Research and Clinical Trial Integrity During and After the Coronavirus Pandemic (JAMA, April 22, 2021)

Callison & Ward discuss the associations between individual characteristics and involuntary health care delays. In this article, older age, fair or poor health, greater education, and health insurance were associated with a greater likelihood of involuntary delays in medical care. Associations Between Individual Demographic Characteristics And Involuntary Health Care Delays As A Result Of COVID-19 (Health Affairs, April 21, 2021)

Teran et al. discuss post-vaccination SARS-CoV-2 infections in a SNF setting. The report describes the 22 breakthrough infections 14 days following a second COVID-19 vaccination, of which two-thirds were asymptomatic. Postvaccination SARS-CoV-2 Infections Among Skilled Nursing Facility Residents and Staff Members — Chicago, Illinois, December 2020–March 2021 (MMWR, April 21, 2021)

Adjemian et. al provide an update on ED visitation trends during the COVID-19 pandemic, now reporting on data from December 2020 to January 2021. In this sample, ED visits were 25% lower than the prior years, and higher proportions of visits were for mental and behavioral health problems. Update: COVID-19 Pandemic-Associated Changes in Emergency Department Visits—Unites States, December 2020-January 2021 (MMWR, April 16, 2021)

Romano et. al comment on trends in racial and ethnic disparities in COVID-19 hospitalizations by region. Within each region, the authors report on the highest proportion of hospitalization among Hispanic or Latino patients. Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region—United States, March-December 2020 (MMWR, April 16, 2021)

Thuy Ho et. al report on US national trends in vascular surgical practice during the pandemic. The authors commented on the expected declines in elective procedures and the unexpected declines in urgent/emergent aortic and carotid interventions. US National Trends in Vascular Surgical Practice During the COVID-19 Pandemic (JAMA Surg, April 15, 2021)

Haffner et. al discuss postop in-hospital morbidity and mortality of patients with COVID-19 compared to patients without. The mortality of patients with COVID-19 was almost double compared to non-COVID patients, although the difference in complications and length of stay between the two groups was not significant. Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection (JAMA Netw Open, April 12, 2021)

Ahmad et al. describe increased death rate using provisional mortality data in the U.S. for 2020. Death rates were highest among persons of color. Heart disease and cancer were the highest causes of death, with COVID-19 as the third leading cause of death. Provisional Mortality Data — United States, 2020 (MMWR, April 9, 2021)

Havervall et al. comment on symptoms and functional impairment eight months following mild COVID-19 infection among health care workers. Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers (JAMA, April 7, 2021)

Yuan et al. in examine clinical practice patterns in remote cardiology clinics during the COVID-19 pandemic. The authors found that compared with pre-COVID, in-person visits, clinicians had significantly lower odds of ordering medications and many tests when visits were completed remotely. Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19 (JAMA Netw Open, April 5, 2021)

Li et al. discuss the impact of telemedicine visits for acute respiratory infections on downstream ED, office, and urgent care visits. Direct-To-Consumer Telemedicine Visits For Acute Respiratory Infections Linked to More Downstream Visits (Health Affairs, April 5, 2021)

Woolf et al. discuss the excess deaths from COVID-19 and other causes from March 1, 2020, to January 2, 2021. This study showed a 22.9% increase in deaths compared to expected rates. Excess Deaths From COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021 (JAMA, April 2, 2021)

Vahratian et al. describe the increase in the rate of adults with recent symptoms of an anxiety or depressive disorder. Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021 (MMWR, April 2, 2021)

Ayoubkhani et al. describe the results of a retrospective study examining readmission rates and all-cause mortality in patients discharged from the hospital with COVID-19 compared to control. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study (BMJ, March 31, 2021)

Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic (JAMA Surg, March 26, 2021)

Seligman et al. discuss trends in 30-day mortality from COVID-19 among older adults in the VA system. From March to November 2020, the average 30-day mortality rate was 19.2%. Regardless of subsequent declines in 30-day mortality reported since, VA and non-VA individuals aged 85 and older remain at highest risk. Trends in 30-day mortality from COVID-19 among older adults in the Veterans Affairs system (JAGS, March 26, 2021-online first)

Alfonso et al. comment on the neglect of US public health spending and its impact on the COVID-19 response. US Public Health Neglected: Flat Or Declining Spending Left States Ill Equipped To Respond To COVID-19 (Health Affairs, March 25, 2021)

In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic (JAMA Netw Open, March 23, 2021)

Van Dyke et al. report on disparities among younger adults. Racial and Ethnic Disparities in COVID-19 Incidence by Age, Sex, and Period Among Persons Aged <25 Years — 16 U.S. Jurisdictions, January 1–December 31, 2020 (MMWR, March 19, 2021)

Prescott discusses symptom variability, patient outcomes following hospitalization. While age and chronic conditions affect “disease manifestations”, it does not explain the “variety of clinical presentations observed”. Outcomes for Patients Following Hospitalization for COVID-19 (JAMA, March 17, 2021)

Assessment of protection against reinfection with SARS-CoV-2 among 4 million PCR-tested individuals in Denmark in 2020: a population-level observational study (Lancet, March 17, 2021)

Madrigal et al. comment on the association between poor functional recovery and delirium, on admission to skilled nursing facilities after heart failure hospitalization. Delirium and Functional Recovery in Patients Discharged to Skilled Nursing Facilities After Hospitalization for Heart Failure (JAMA Netw Open, March 16, 2021)

Kosar et al. comment on observed decrease in COVID-19 mortality rates among nursing home residents, though efforts to improve detection of asymptomatic cases do not explain this trend. COVID-19 Mortality Rates Among Nursing Home Residents Declined From March To November 2020 (Health Affairs, March 11, 2021)

Nugent et al. discuss the long-term impact of COVID-19 on kidney function among patients discharged from the hospital. Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19 (JAMA Netw Open, March 10, 2021)

Jacob et al. comment on risk factors associated with SARS-CoV-2 seropositivity among US health care personnel, concluding that current infection prevention strategies are effective in preventing virus transmission in the workplace. Risk Factors Associated with SARS-CoV-2 Seropositivity Among US Health Care Personnel (JAMA Netw Open, March 10, 2021)

In Traditional Medicare, Modest Growth In The Home Care Workforce Largely Driven By Nurse Practitioners (Health Affairs, March 1, 2021)

Follow-up Survey of US Adult Reports of Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, September 2020 (JAMA Netw Open, February 19, 2021)

Sequelae in Adults at 6 Months After COVID-19 Infection (JAMA Netw Open, February 19, 2021)

Uscher-Pines et al. report on use of in-person, telephone and video visits among California’s Federally Qualified Health Centers. The authors argue eliminating coverage of telephone visits post-pandemic may disproportionately affect underserved populations. Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic (JAMA, February 2, 2021)

Older adults’ perspectives on a COVID-19 vaccine (JAMA Health Forum, December 23, 2020)

Persistent symptoms after Covid-19: qualitative study of 114 “long Covid” patients and draft quality principles for services (BMC Health Serv Res, December 20, 2020)

Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system (JAMA, December 14, 2020)

Household transmission of SARS-CoV-2: A systematic review and meta-analysis (JAMA Netw Open, December 14, 2020)

Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection (JAMA Oncol, December 10, 2020)

Assessment of racial/ethnic disparities in hospitalization and mortality in patients with COVID-19 in New York City (JAMA Netw Open, December 4, 2020)

Increased intensity of PCR testing reduced COVID-19 transmission within countries during the first pandemic wave (Health Aff, December 2, 2020)

Increasing critical care nurse engagement of palliative care during the COVID-19 pandemic (Crit Care Nurse, December 1, 2020)

Estimated SARS-CoV-2 seroprevalence in the US as of September 2020 (JAMA Intern Med, November 24, 2020)

Delirium in older patients with COVID-19 presenting to the emergency department (JAMA Netw Open, November 19, 2020)

Characteristics of hospitalized COVID-19 patients discharged and experiencing same-hospital readmission—United States, March-August 2020 (MMWR, November 13, 2020)

Jan Hoffman for the NYT writes on the willingness of Latino adults to receive COVID-19 vaccinations, despite low current vaccination rates in this population. (Also see Hamel et al., for KFF survey results.) After initial hesitation, a survey finds that many Latinos in the U.S. now want the Covid vaccine (NYT, May 14, 2021)

Hamel et al. report on the ongoing KFF COVID-19 Vaccine Monitor project that highlights the disproportionate toll the pandemic has taken on Hispanic adults in the U.S. Many express concerns that reflect access-related barriers to vaccination, including missing work due to side effects, out of pocket costs despite the fact the vaccine is free, receiving vaccine in a trusted place, or being able to travel to a vaccination site. COVID-19 Vaccine Access, Information, and Experiences Among Hispanic Adults in the U.S. (KFF, May 13, 2021)

Michael Ollove discusses the impact of long-haul COVID-19 on renewed efforts to extend home- and community-based palliative care. Long-haul covid-19 renews push to expand palliative care (Washington Post, May 10, 2021)

Reed Abelson comments on families’ perspectives on nursing homes following the pandemic. Covid Forces Families to Rethink Nursing Home Care (NYT, May 6, 2021)

In the latest Long-Term Care Poll on trends in aging at home, 88% of respondents would prefer to receive ongoing care at home or with loved ones as they age. The greatest concern reported was losing their independence. More than half also received health care at home via telehealth during the pandemic. Long-Term Care in America: Americans Want to Age at Home (The Associated Press-Center for Public Affairs Research, May 3, 2021)

Apoorva Mandavilli discusses the possibility of herd immunity not being attainable in the foreseeable future. Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe (NYT, May 3, 2021)

Jonathan Rothwell discusses how education impacts job loss during the pandemic. How Social Class Affects Covid-Related Layoffs Worldwide (NYT, May 3, 2021)

Corallo et al. report on challenges community health centers providing COVID-19 vaccinations are currently experiencing. Staffing clinics has increasingly become more of a challenge than vaccine supply, based on the KFF poll. Most Common Challenge for Community Health Centers Has Shifted from Vaccine Supply to Staffing Needed to Meet Demand (KFF April 22, 2021)

Kari Webb, a nurse, and her family share their experience as healthcare workers, and her recovery from the virus and a double lung transplant. Searching for footing in a life nearly extinguished by COVID (AP, April 22, 2021)

Since the start of 2021, hospitalizations of older adults in the US have fallen as more vaccinations occur. COVID-19 hospitalizations tumble among US senior citizens (AP, April 22, 2021)

The virus has left many Americans with long-term, often debilitating symptoms. Numerous studies have demonstrated how palliative care improves the quality of life for patients. Expanding the full array of palliative care service delivered in patients’ homes is needed. Long-Haul COVID Renews Push to Expand Palliative Care (Stateline, PEW April 20, 2021)

An inside look at nurses and home health aides in long-term services and supports with Bryce Covert. ‘They Just Feel That They’ve Been Violated’ (The Atlantic, April 16, 2021)

Weiland and Smith discuss the Biden administration’s response to surging COVID cases in Michigan. Surging Virus Has Michigan’s Democratic Governor at Loggerheads with Biden (NYT, April 12, 2021)

Larson and Stroud introduce NASEM report findings and recommendations for research and to improve dementia care. Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers (JAMA, April 9, 2021)

Many patients have neurological complaints post-infection, regardless of the severity of their symptoms. Clinics across the US are helping ‘long COVID’ [Post-Acute Sequelae of SARS-CoV-2 infection (PASC)] patients with lingering neurocognitive problems. The Way Out of Brain Fog (The Atlantic, April 9, 2021)

In latest “Transforming Care” brief, Hostetter and Klein discuss patient engagement that goes beyond satisfaction surveys, and present examples of community partnerships during the pandemic. Beyond the Survey: Engaging Patients and Communities as Partners (The Commonwealth Fund, April 8, 2021)

The Washington Post/KFF Survey Project: Latest poll reveals the mental health challenges facing frontline health care workers. More than half reported worry or stress has had a negative impact on their mental health. Stress on the front lines of COVID-19 (Washington Post, April 6, 2021; KFF, April 6, 2021)

Sheri Fink for the NYT reviews a LA hospital’s efforts to support COVID-19 patients following ICU stays. ‘It Takes Time’: I.C.U. Workers Help Their Former Covid Patients Mend (NYT, April 1, 2021)

What COVID-19 Taught Us About Telemedicine (WSJ, March 28, 2021)

Kamp discusses the evidence that the COVID-19 vaccine effort is protecting older Americans. The Covid-19 Vaccine Effort Is Protecting Older People, Growing Evidence Suggests (WSJ, March 26, 2021)

Riley et al. discuss the management of Medicare beneficiaries with chronic illnesses during the COVID-19 pandemic who are at further risk due to disruption in essential health services. CMS has deployed strategies such as waivers to expand telemedicine services and shift more services to outpatient and home-based care. Managing Medicare Beneficiaries with Chronic Conditions During the COVID-19 Pandemic (The Commonwealth Fund, March 18, 2021)

Reed Abelson discusses concerns following delayed cancer screenings. Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings (NYT, March 17, 2021)

Pam Belluck discusses preprint information on long-term effects on COVID-19 in non-hospitalized patients. Many ‘Long Covid’ Patients Had No Symptoms From Their Initial Infection (NYT, March 8, 2021)

High Staff Turnover at U.S. Nursing Homes Poses Risks for Residents’ Care (NYT, March 1, 2021)

Mehrotra et al. provide an update on the impact of COVID-19 on outpatient visits in 2020. This report showed a cumulative 5-6% decrease in weekly outpatient visits in 2020. The Impact of COVID-19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases (The Commonwealth Fund, February 22, 2021)

When COVID-19 Hit, Mayo Clinic Had to Rethink Its Technology (WSJ, February 21, 2021)

‘We Are Going to Keep You Safe, Even if it Kills Your Spirit’ (NYT, February 19, 2021)

The many strange long-term symptoms of Covid-19, explained (Vox, December 15, 2020)

Covid survivors with long-term symptoms need urgent attention, experts say (NYT, December 4, 2020)

More than 15% of Americans have had COVID-19, CDC Estimates (WSJ, November 27, 2020)

Exercise after COVID-19? Take it slow (NYT, November 17, 2020)

Reflections of a COVID-19 long hauler (A piece of my mind) (JAMA, November 11, 2020)