After receiving a second dose of the Moderna vaccine last spring, the locus of my personal anxiety around contracting COVID-19 shifted from hoping that I wouldn’t die or need hospitalization to the slightly-less-dire wish to not sustain long-term lung, brain, or heart damage.
I didn’t want anyone to be sick from COVID, and while being vaccinated offered some measure of protection and relief from worrying about some of the worst consequences of the illness, more and more people were reporting concerning long-term symptoms. Muscle and joint pain lasting for weeks and months longer than the initial infection. Fatigue and brain fog that just wouldn’t clear. Persistent gastrointestinal distress, ongoing sleep disturbances, troubling headaches, and postural dizziness. While most people who contract COVID-19 feel better within a few weeks, a significant minority of individuals experience post-COVID symptoms commonly referred to as “long COVID.” (Health care professionals sometimes use the term “post-acute sequelae of COVID-19,” or PASC.)
For 35-year-old, Moms Clean Air Force Nevada organizer Jennifer Ann Cantley, who lives with her family in Carson City, long COVID has been a waking nightmare—she is actually living the harrowing scenario that people like me have been ruminating about behind our masks for almost two years. Months after her initial COVID diagnosis, Jennifer still hasn’t regained a normal sense of taste or smell—her diet has been radically altered by a syndrome called parosmia, in which normal odors can become grotesquely distorted. She can no longer eat meat, onions, tomatoes, garlic, or coffee; they all smell like “mildew or a rotting body.” With a case of long COVID that’s far more serious than fatigue and brain fog, Jennifer has been diagnosed with pseudotumor cerebri, a rare form of hydrocephalus that manifests as elevated spinal fluid pressure in the brain, and mild chronic obstructive pulmonary disease (COPD), with accompanying polyps on her lungs.
Though her illness may be severe, Jennifer is not alone. Estimates about the prevalence of long COVID vary substantially, but one study from the UK found that lingering COVID symptoms occurred in approximately 12% of individuals 12 weeks after initial infection. Two full years into the pandemic, it’s not yet clear exactly what causes some people to experience long COVID while others recover fully, though recent research highlights a few variables scientists think may be risk factors for long COVID. Factors include the initial level of coronavirus RNA early in infection, which is an indicator of how much virus is in the body; the presence of certain autoantibodies, which are antibodies that erroneously attack the body’s own tissues; reactivation of Epstein-Barr virus, a common virus that infects most people, then typically becomes dormant; and type 2 diabetes. It’s also not yet clear whether vaccination offers protection against long COVID among individuals who have breakthrough infections, though it’s important to note that vaccines do reduce the risk of long-haul COVID by reducing the risk of getting COVID in the first place.
When people contract COVID-19, a number of factors can make them more vulnerable to serious initial illness, such as older age and pre-existing conditions. Another concerning risk factor for serious illness is air pollution: according to a study conducted at Harvard, long-term exposure to air pollution is linked to a higher risk of dying from COVID-19. Researchers found that each 1 microgram/cubic meter increase in air pollution was associated with an 11% increase in mortality risk from COVID (for context, according to the Harvard T.H. Chan School of Public Health, many Americans breathe air that contains 8 micrograms/cubic meter of particulate matter pollution). Another study found that wildfires amplified the short-term effects of exposure to air pollution, likely contributing to excess COVID-19 cases and deaths. The health burdens of air pollution fall disproportionately on communities of color, as these communities are exposed to higher levels of air pollution regardless of geographic region or income level. People of color have also been disproportionately impacted by COVID-19 throughout the pandemic.
While research hasn’t yet directly linked air pollution to long COVID risk or severity, air pollution has been linked to illnesses in multiple body systems in much the same way that COVID has. Not just a respiratory issue, exposure to air pollution has been linked to increased risk of neurological dysfunction, cognitive decline, and cardiovascular problems (for starters). Scientists think that inflammation may be part of the biological pathway through which air pollution contributes to multi-system disease, but more research is needed.
For COVID “long haulers” like Jennifer, the connections between long COVID and air pollution are clearer. Conditions like COPD make people more vulnerable to the respiratory impacts of air pollution, such as the pollution that comes from wildfires: “From the wildfires lasting in Nevada from the end of May to late September,” she tells me, “I am pretty much trapped in my house now because of how I breathe.” She’s acutely aware that climate change’s exacerbating effects on air pollution will affect her more because of long COVID. Simple things, like going for a walk outside with her family, aren’t simple for her anymore.
Two years into the reality of living with an airborne virus, many of us have a deeper appreciation of how what’s in the air we breathe impacts our health than ever before. I’m still anxious about contracting long COVID myself, and for the millions of people suffering with this strange and poorly understood illness, I hope research will offer effective treatment solutions soon. For now, though, I’m reminded not to take for granted the ability to take a deep breath of clean air—it’s a privilege far too many are denied.